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Sentinel Lymph Node Localization in Early Breast Cancer

Divisions of Nuclear Medicine and Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine and Jackson Memorial Medical Center, Miami, Florida; Nuclear Medicine Department, Bay Pines VA Medical Center, Bay Pines, Florida; Division of Surgical Oncology, University of Vermont Medical Center, Burlington, Vermont

Correspondence: For correspondence or reprints contact: Frederick L. Moffat, MD, Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave., Miami, FL 33136.

ABSTRACT

Methods: Thirty-two patients with clinical node-negative breast cancer underwent sentinel node localization study as part of a National Cancer Institute-sponsored multicenter trial. Anatomical and histopathologic characteristics of sentinel lymph node (SLN) and a kinetic analysis of nodal uptake were studied. Patients were injected with 1 mCi/4 ml unfiltered ^99mTc-sulfur colloid in four divided doses around the palpable lesion or immediately adjacent to the excision cavity if prior biopsy was performed. SLN biopsy was performed 1.5–6 hr (mean = 3 hr) postinjection. Intraoperative localization was performed using a gamma probe. All patients underwent complete axillary dissection. Results: SLN was identified in 30 of 32 (94%) patients. There were no false-negative SLN biopsies. Conclusion: This study supports the clinical validity of SLN biopsy in breast cancer and confirms that, unlike the blue dye technique, the learning curve with unfiltered ^99mTc-sulfur colloid and the gamma detection probe is short, and SLN localization is achievable in over 90% of cases by surgeons with modest experience. The use of unfiltered ^99mTc-sulfur colloid (larger particle size) with larger injected volume permits effective localization of SLNs.

Key Words: breast cancer • sentinel node • sulfur colloid • intraoperative gamma probe

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