Original Scientific Articles
Sentinel lymph node biopsy in breast cancer: unfiltered radioisotope is superior to filtered1,

https://doi.org/10.1016/S1072-7515(98)00314-7Get rights and content

Abstract

Background: The combination of gamma-probe radiolocalization and blue-dye mapping of sentinel lymph nodes (SLNs) has been advocated as the most accurate method for staging the clinically negative axilla in breast cancer patients, but the technical aspects of these procedures are not fully characterized in the literature. In this study, we compared the success of SLN localization in 134 consecutive breast cancer patients using blue dye plus two different preparations of radiocolloid.

Study Design: A retrospective analysis of a prospectively maintained data base was performed to assess SLN localization in two cohorts of patients. Unfiltered technetium-99m (Tc-99m) sulfur colloid (in 77 patients; group I) was compared with filtered Tc-99m sulfur colloid (in 57 patients; group II). All patients had a peritumoral injection of blue dye and isotope, followed immediately by lymphoscintigraphy to confirm radioactivity at the injection site and to image the SLN. Statistical analysis was performed using the Pearson chi-square test.

Results: Unfiltered Tc-99m sulfur colloid was superior to the filtered radiocolloid in localizing the SLN (88% versus 73%; p = 0.03). SLN imaging by lymphoscintigraphy was also more successful in the unfiltered group. Using the combination of blue dye and radiolocalization, SLNs were identified in 94% of patients.

Conclusions: For optimal localization of the SLN in breast cancer patients, surgeons should use the combined technique of blue-dye mapping and gamma-probe localization using unfiltered Tc-99m sulfur colloid.

Section snippets

Methods

Between October 1996 and August 1997, 134 patients with T1-2N0 breast cancer had SLN biopsy at Memorial Sloan-Kettering Cancer Center. Informed consent (under Institutional Review Board Protocol no. 96-049) was obtained before each procedure. All patients had biopsy-proved T1-2 invasive breast cancer with clinically negative axillary nodes. Patients who were pregnant, had clinically suspicious nodes, or were found on final pathologic review to have only in situ disease were excluded.

The initial

Results

The clinical characteristics of the group I and group II patients were comparable (Table 1). The estimated range of particle sizes present in unfiltered Tc-99m sulfur colloid is 10 to 200 μm. Figure 1 demonstrates the heterogeneity characteristic of the standard unfiltered preparation as measured in 43 of our patients. From one batch of unfiltered sulfur colloid to the next, the proportion of the total radioactivity dose passing through a 0.22-μm filter ranged from 12% to 42%.

All patients had

Discussion

ALND is of no benefit to the increasing proportion of breast cancer patients with pathologically negative axillary nodes, and in this context, SLN biopsy has emerged as a minimally invasive and reliable method of staging the clinically negative axilla. Although the landmark studies of Giuliano and colleagues9 advocated the use of blue dye alone, the concurrent use of blue dye and gamma-probe radiolocalization has increased the likelihood of successful SLN biopsy, both in the experience of

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The authors are grateful to the Tow Foundation and to the Liz Claiborne Foundation for the support of sentinel node programs at MSKCC.

1

No competing interests declared.

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