Sentinel lymph node identification in breast cancer patients(314 views) Fonti R, Limite G, Sodano A, Riccardi A, Forestieri P, De Cristofaro G, Pettinato G, Salvatore M
Radiol Med (ISSN: 0033-8362, 1826-6983, 1826-6983electronic), 2002 Apr; 103(4): 370-377.
Keywords: Breast Cancer, Lymphoscintigraphy, Sentinel Lymph Node, Diagnostic Agent, Macrosalb Tc 99m, Technetium Tc 99m Nanocolloid, Adult, Article, Axilla, Breast Tumor, Cancer Staging, Female, Human, Lymph Node Metastasis, Lymphadenectomy, Middle Aged, Pathology, Prediction And Forecasting, Scintiscanning, Sentinel Lymph Node Biopsy, Breast Neoplasms, Lymph Node Excision, Lymphatic Metastasis, Neoplasm Staging, Predictive Value Of Tests, Technetium Tc 99m Aggregated Albumin,
Affiliations: *** IBB - CNR ***
Dipto. Assistenziale Diagnostica P., Univ. Studi di Napoli Federico II, Napoli, Italy
Dipartimento di Chirurgia, Generale ed Oncologia, Univ. Studi di Napoli Federico II, Napoli, Italy
Ist. di Anat. e Istologia Patologica, Univ. Studi di Napoli Federico II, Napoli, Italy
CNR, Centro per la Medicina Nucleare, Univ. Studi di Napoli Federico II, Napoli, Italy
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Cabanas, P. A., Solomon, R. J., Vilcoq, J. R., Value of axillary dissection in addiction to lumpectomy and radiotherapy in early breast cancer (1992) Lancet, 39, pp. 1245-1248
Ivens, D., Loe, A. L., Podd, T. J., Assessment of morbidity from complete axillary dissection (1992) Br J Cancer, 66, pp. 136-138
Giuliano, A. E., Kirgan, D. M., Guenther, J. M., Lymphatic mapping and sentinel lymphadenectomy in breast cancer (1994) Ann Surg, 220, pp. 391-401
Mansel, R. E., Khonji, N. I., Clarke, D., History, present status and future of sentinel node biopsy in breast cancer (2000) Acta Oncol, 39, pp. 265-268
Cabanas, R. M., An approach for the treatment of penile carcinoma (1977) Cancer, 39, pp. 456-466
Alazraki, N. P., Eshima, D., Eshima, L. A., Lymphoscintigraphy, the sentinel node concept and the intraoperative gamma probe in melanoma, breast cancer and other potential cancers (1997) Semin Nucl Med, 27, pp. 55-67
Keshlgar, M. R. S., Ell, P. J., Sentinel lymph node detection and imaging (1999) Eur J Nucl Med, 26, pp. 57-67
Leong, S. P. L., Steinmetz, I., Habib, F. A., Optimal selective sentinel lymph node dissection in primary malignant melanoma (1998) Arch Surg, 112, pp. 666-673
Alazraki, N. P., Styblo, T., Grant, S. F., Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma-detecting probe (2000) Semin Nucl Med, 30, pp. 56-64
Borgstein, P. J., SLN biopsy in breast cancer: Guidelines and pitfalls of lymphoscintigraphy and gamma probe detection (1998) J Am Coll Surg, 186, pp. 275-283
Cox, C. E., Pendas, S., Cox, J. M., Guidelines for SN biopsy and lymphatic mapping of patients with breast cancer (1998) Ann Surg, 227, pp. 645-653
Haigh, P. I., Giuliano, A. E., Role of sentinel lymph node dissection in breast cancer (2000) Ann Med, 32, pp. 51-56
Martin, R. C., Ewards, M. J., Wong, S. L., Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: Results of a multi-institutional study. For the university of Louisville breast cancer study group (2000) Surgery, 128, pp. 139-144
Hainsworth, P. J., Tjandra, J. J., Stillwell, R. G., Detection and significance of occult metastastases in node-negative breast cancer (1993) Br J Surg, 80, pp. 459-483
(1990) Lancet, 335, pp. 1565-1568
Giuliano, A. E., Dale, P. S., Turner, R. R., Improved axillary staging of breast career with sentinel lymphadenectomy (1995) Ann Surg, 222, pp. 394-401
Sentinel lymph node identification in breast cancer patients
Purpose. To evaluate the predictive value of sentinel lymph node biopsy versus axillary node dissection on lymph node status in patients with T1-T2 breast cancer. Material and methods. Twentynine patients with T1 and 12 with T2 breast carcinoma and clinically NO axillary lymph nodes, underwent lymphoscintigraphy following the administration of 99mTc-human albumin nanocolloids. The tracer was injected subdermally, over the tumor mass, in the 34 patients with palpable lesions and peritumorally (n=3) or intratumorally (n=4), under stereotactic or ultrasound guidance, in the 7 patients with non-palpable lesions. Anterior and lateral planar images were acquired 15 min after the injection of the tracer and repeated every 30 min up to 3 hr until identification of sentinel lymph node. At the end of the scintigraphic study, sentinel node skin projection was marked using a demographic pen. Eighteen hours after lymphoscintigraphy, sentinel lymph node was identified and removed during surgery by hand-held gamma probe, then, the remaining axillary lymph nodes were dissected. All surgical specimens underwent histologic examination. Sentinel lymph nodes free of metastasis at histology, underwent additional examination with immunohistochemistry using monoclonal antibodies against cytokeratin and EMA to search for micrometastases. Results. Sentinel lymph node was identified in the 34 patients injected subdermally and in the 3 patients injected peritumorally, while it remained undetected in the 4 patients injected intratumorally except for one case in which it was isolated by radioguided surgery but not scintigraphically. Sentinel nodes resulted free of metastases both at histology and immunohistochemistry in 32 cases and metastatic in 6. In the 32 patients with non-metastatic sentinel lymph nodes the other axillary nodes were also free of metastases. Among the 6 metastatic sentinel lymph nodes, in 3 cases they were the only metastatic nodes of the axilla while in the other 3 cases metastases were spread to other axillary nodes. Conclusions. In agreement with previous studies, our results showed that sentinel lymph node radioguided biopsy is a simple and reliable method for predicting axillary lymph nodes status and for avoiding axillary dissection in early breast cancer patients with sentinel node free of metastases.
Sentinel lymph node identification in breast cancer patients
Cusanno F, Cisbani E, Colilli S, Fratoni R, Garibaldi F, Giuliani F, Gricia M, Lucentini M, Magliozzi ML, Santarivenere F, Torrioli S, Cinti MN, Pani R, Pellegrini R, Simonetti G, Schillaci O, Del Vecchio S, Salvatore M, Majewski S, De Vincentis G, Scopinaro F * Results of clinical trials with SPEM(278 views) Nucl Instrum Methods Phys Res Sect A, 2007 Feb 1; 497(1): 46-50. Impact Factor:3.221 ViewExport to BibTeXExport to EndNote