Advertisement

Value of sentinel node biopsy in the management of breast cancer

  • R. Manecksha
  • A. D. K. Hill
  • B. Dijkstra
  • L. Kelly
  • C. D. Collins
  • E. McDermott
  • N. J. O’Higgins
Original Paper

Abstract

Aims

To determine the rate of detection of the sentinel node using both blue dye and radioisotope, and the accuracy with which the sentinel node histology reflects the nodal status of the axilla in a series of patients with clinically node-negative breast cancer.

Patients and methods

During a 32-month period from May 1998 to December 2000, 73 patients with clinically node-negative breast cancer underwent sentinel node biopsy immediately followed by formal axillary lymphadenectomy. The sentinel node(s) was identified using a combination of lymphoscintigraphy, blue dye and an intraoperative hand-held gamma probe.

Results

The mean age of the 73 patients was 58 years (range 32–83 years). Twenty-six per cent (19/73) had previous surgical/excisional biopsy. Pre-operative lymphoscintigraphy was positive in 74% (54/73) of patients. Combination of blue dye and radioisotope was better than either method in isolation for identifying the sentinel node, yielding a success rate of 96% (70/73). A total of 32 cases proved to have positive nodal disease on histological examination. In 44% (14/32) of patients, the sentinel node was the only positive node. Forty-seven per cent (15/32) of patients in whom the sentinel node was positive also had positive nodes in the axillary nodal basin. There were 3/32 false negative cases, giving a false negative rate of 9.4%.

Conclusion

Sentinel node biopsy will have a role in the management of breast cancer. However, widespread adaptation of this technique awaits the results of prospective, randomised trials.

Keywords

Breast Cancer Sentinel Node Sentinel Node Biopsy Axillary Lymph Node False Negative Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Rosen PP, Groshen S, Saigo P, Kinne DW, Hellman S. A long-term follow up study of survival in Stage I (T1N0M0) and Stage II (T1N1M0) breast carcinoma.J Clin Oncol 1989; 7: 355–66.PubMedGoogle Scholar
  2. 2.
    Glass EC, Essner R, Guiliano AE. Sentinel node localisation in breast cancer.Semin Nucl Med 1999; 29: 57–68.CrossRefPubMedGoogle Scholar
  3. 3.
    Alazraki NP, Eshima LA, Herda SC et al. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers.Semin Nucl Med 1997; 27: 55–67.CrossRefPubMedGoogle Scholar
  4. 4.
    Valdes Olmos RA, Hoefnagel CA, Nieweg OE et al. Lymphoscintigraphy in oncology: a rediscovered challenge.Eur J Nucl Med 1999; 26 (4 Suppl): S2-S10.CrossRefPubMedGoogle Scholar
  5. 5.
    Taylor A Jr, Murray D, Herda S, Vansant J, Alazraki N. Dynamic lymphoscintigraphy to identify the sentinel node and satellite nodes.Clin Nucl Med 1996; 21: 755–8.CrossRefPubMedGoogle Scholar
  6. 6.
    O’Hea BJ, Hill AD, El-Shirbiny AM et al. Sentinel node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center.J Am Coll Surg 1998; 186: 423–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Hill AD, Tran KN, Akhurst T et al. Lessons learnt from 500 cases of lymphatic mapping for breast cancer.Ann Surg 1999; 229: 528–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Gulec SA, Moffat FL, Carroll RG et al. Sentinel lymph node localisation in early breast cancer.J Nucl Med 1998; 39:1388–93.PubMedGoogle Scholar
  9. 9.
    Krag D, Weaver D, Ashikaga T et al. The sentinel node in breast cancer — a multicentre validation study.New Eng J Med 1998; 339: 941–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Morgan A, Howisey RL, Aldape HC et al. Initial experience in a community hospital with sentinel lymph node mapping and biopsy for evaluation of lymph node status in palpable invasive breast cancer.J Surg Oncol 1999; 72 (1): 24–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Veronesi U, Paganelli G, Galimberti V et al. Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes.Lancet 1997; 349 (9069): 1864–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Sandrucci S, Casalegno PS, Percivale P et al. Sentinel lymph node mapping and biopsy for breast cancer: a review of the literature relative to 4,791 procedures.Tumori 1999; 85 (6): 425–34.PubMedGoogle Scholar
  13. 13.
    Dunnwald LK, Mankoff DA, Byrd DR et al. Technical aspects of sentinel node lymphoscintigraphy for breast cancer.J Nucl Med Technol 1999; 27 (2): 106–11.PubMedGoogle Scholar
  14. 14.
    Paganelli G, de Cicco C, Cremonesi M et al. Optimised sentinel node scintigraphy in breast cancer.Q J Nucl Med 1998; 42 (1): 49–53.PubMedGoogle Scholar
  15. 15.
    Alazraki NP, Styblo T, Grant SF et al. Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma-detecting probe.Semin Nucl Med 2000; 30(1) 56–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Rodier JF, Routiot T, Mignotte H et al. Lymphatic mapping and sentinel node biopsy of operable breast cancer.World J Surg 2000; 24 (10):1220–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Tafra L, Lannin DR, Swanson MS et al. Multicentre trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye.Ann Surg 2001; 233: 51–9.CrossRefPubMedGoogle Scholar
  18. 18.
    de Kanter AY, van Geel AN, Paul MA et al. Controlled introduction of the sentinel node biopsy in breast cancer in a multicentre setting: the role of a coordinator for quality control.Eur J Surg Oncol 2000; 26: 652–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2001

Authors and Affiliations

  • R. Manecksha
    • 2
  • A. D. K. Hill
    • 2
  • B. Dijkstra
    • 2
  • L. Kelly
    • 2
  • C. D. Collins
    • 1
  • E. McDermott
    • 2
  • N. J. O’Higgins
    • 2
  1. 1.Departments of Surgery and RadiologySt Vincent’s University HospitalDublinIreland
  2. 2.St Vincent’s University HospitalDublinIreland

Personalised recommendations