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Breast Cancer

, Volume 5, Issue 4, pp 389–393 | Cite as

Efficacy and Significance of Sentinel Lymph Node Identification with Technetium-99m-labeled Tin Colloids for Breast Cancer

  • Kazuhiko Sato
  • Hoshio Hiraide
  • Minoru Uematsu
  • Kuniyoshi Tamaki
  • Hirofumi Ishikawa
  • Tamio Yamasaki
  • Seiichi Tamai
  • Shoichi Kusano
  • Hidetaka Mochizuki
Original Article

Abstract

Purpose

The sentinel lymph node (SLN) is thought to reflect the metastatic status of the remaining axillary lymph nodes in patients with breast cancer. We used technetium-99m-labeled tin colloids to identify SLN. The efficacy and significance of SLN identification using this method were investigated in terms of number, size, location, and tumor metastasis. The efficacy of the emulsion charcoal injection method for the intraoperative visible identification of SLN was also evaluated.

Methods

Twenty-five patients with invasive breast cancer were studied. Under ultrasonographic guidance, technetium-99m-labeled tin colloid particles (3 ml) were injected into 3 sites around the tumor within 3 mm of the margin or into the wall of the excisional biopsy cavity 2 hours before surgery. At surgery, just before the incision, an emulsion of charcoal particles (2.5 ml) was injected into 3 sites of the breast parenchyma surrounding the tumor. All patients underwent mastectomy with axillary dissection to the infraclavicular region. The radioactivity of each dissected lymph node was measured. All axillary specimens were processed in individual blocks for permanent section histopathologic evaluation with H &E.

Results

SLN were defined as lymph nodes with 100 000 or more counts per minute (cpm) in radioactivity after injection of labeled tin colloids. In all 25 patients, SLN were identified (mean, 1.9 SLN/patient; range,l-4). Since the mean uptake in SLN was 383 124 cpm, but only 884 cpm in non-SLN nodes, discrimination between SLN and non-SLN nodes was easy. Clearly visible lymph nodes with charcoal staining accounted for 83.3% of all SLN, although 21.3% of non-SLN also stained. SLN were located only in the axillary region, but there were no other specific features in the location or size of SLN. The SLN were metastatic in 10 of the 25 patients: in 4, the SLN were the only metastatic nodes whereas in the remaining 6 patients, other axillary nodes were also positive. Fifteen patients with no metastasis in SLN had no tumor involvement in any other lymph nodes. There were no skip metastases.

Conclusion

SLN identified with labeled tin colloids have clinical value in predicting the metastatic status of the remaining axillary lymph nodes in breast cancer.

Key words

Breast cancer Axillary dissection Sentinel lymph node 

Abbreviations

SLN

Sentinel lymph node(s)

ALND

Axillary lymph node dissection

cpm

Counts per minute

H & E

Hematoxylin and eosin staining

n.s.

No significance

SLND

Sentinel lymph node dissection

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Copyright information

© The Japanese Breast Cancer Society 1998

Authors and Affiliations

  • Kazuhiko Sato
    • 1
  • Hoshio Hiraide
    • 2
  • Minoru Uematsu
    • 3
  • Kuniyoshi Tamaki
    • 1
  • Hirofumi Ishikawa
    • 1
  • Tamio Yamasaki
    • 4
  • Seiichi Tamai
    • 5
  • Shoichi Kusano
    • 3
  • Hidetaka Mochizuki
    • 1
  1. 1.1st Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
  2. 2.Research CenterNational Defense Medical CollegeJapan
  3. 3.Department of RadiologyNational Defense Medical CollegeJapan
  4. 4.lst Department of PathologyNational Defense Medical CollegeJapan
  5. 5.Department of Clinical PathologyNational Defense Medical CollegeJapan

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