Sentinel node biopsy (SNB) is rapidly emerging as the preferred technique for nodal staging in breast cancer. When radioactive colloid is used, a preoperative lymphoscintiscan is obtained to ease sentinel lymph node (SN) identification. This study evaluates whether preoperative lymphoscintigraphy adds diagnostic accuracy to offset the additional time and cost required. 823 breast cancer patients underwent SNB based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 99 mTc-nanocolloid and Patent Blue V injected peritumourally. The SNB was followed by standard axillary treatment at the same operation. Preoperative lymphoscintigraphy was performed around 3 h after the radioisotope injection. Preoperative lymphoscintigraphy revealed SNs in 593 (72%) of the 823 patients imaged. SN visualisation on lymphoscintigraphy was less successful in large tumours and tumours involving the upper outer quadrant of the breast (P=0.046, P<0.001, respectively). Lymphoscintigraphy showed internal mammary sentinel nodes in 9% (62/707) patients. The SN was identified intraoperatively in 98% (581) patients who had SN visualised on preoperative lymphoscintigraphy, with a false-negative rate of 7%. In patients who did not have SN visualised on preoperative lymphoscintigraphy, the SN was identified at operation in 90% (204) patients, with a false-negative rate of 7%. The SN identification rate was significantly higher in patients with SN visualised on preoperative lymphoscintigraphy (P<0.001). SN identification rate intraoperatively using the gamma probe was significantly higher in the SN visualised group compared with the SN non-visualised group (95% vs. 68%; chi square (1 degrees of freedom (df)) P<0.001. There was no statistically significant difference in the false-negative rate and the operative time between the two groups. A mean of 2.3 (standard deviation (SD) 1.3) SNs per patient were removed in patients with SN visualised on preoperative lymphoscintigraphy compared with 1.8 (SD 1.2) in patients with no SN visualised on lymphoscintigraphy (P<0.001). Although SN visualisation on preoperative lymphoscintigraphy significantly improved the intraoperative SN localisation rate, SN was successfully identified in 90% of patients with no SN visualisation on lymphoscintigraphy. Given the time and cost required to perform routine preoperative lymphoscintigraphy, these data suggest that it may not be necessary in all cases. It may be valuable for surgeons in the learning phase to shorten the learning curve and in patients who have increased risk of intraoperative failed localisation (obese or old patients). A negative preoperative lymphoscintiscan predicts the inability to localise with the hand-held gamma probe. Therefore, if the SN is not visualised on lymphoscintigraphy then the addition of intraoperative blue dye is recommended to increase the likelihood of SN identification.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.ejca.2004.05.008 | DOI Listing |
Breast
December 2024
University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University Oldenburg, 26121, Germany.
Objective: The necessity of preoperative lymphoscintigraphy before intraoperative sentinel lymph node (SLN) identification is still unclear. The aim of the present study was to evaluate the impact of SLN imaging on intraoperative SLN detection in breast cancer patients.
Methods: Retrospective, comparative, single center study of patients with breast cancer stage pT1 and pT2 who underwent axillary staging.
Asia Ocean J Nucl Med Biol
January 2025
Nuclear Medicine Research Center, Mashhad university of Medical Sciences, Mashhad, Iran.
Breast cancer lymphoscintigraphy is a crucial tool in pre-operative assessment, typically revealing sentinel lymph node drainage patterns within axillary and extra-axillary regions. However, rare cases challenge conventional understanding. We report a 67-year-old woman with breast cancer, where lymphoscintigraphy revealed focal uptake within the falciform ligament of the liver, an exceedingly rare phenomenon.
View Article and Find Full Text PDFAnn Nucl Med
December 2024
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
Objective: To explore the clinical efficiency of using the sentinel lymph node (SLN) imaging agent Tc-rituximab for lymphoscintigraphy and SLN biopsy (SLNB) in oral squamous cell carcinoma (OSCC) patients.
Methods: A retrospective study was conducted on 23 patients with OSCC who underwent Tc-rituximab lymphoscintigraphy and SLNB. The cohort comprised 16 men (69.
Gland Surg
November 2024
Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Background: Sentinel lymph node biopsy (SNB) using radioisotopes is a standard method for assessing axillary lymph node status in patients with breast cancer. Although preoperative lymphoscintigraphy can estimate the number of sentinel lymph nodes (SNs), multiple radioactive SNs are often identified, even when lymphoscintigraphy reveals only one SN. Importantly, metastases are not always observed in the most radioactive SN (hottest SN).
View Article and Find Full Text PDFEur J Surg Oncol
January 2025
Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
Introduction: Determining sentinel lymph node (SLN) status is important for treatment decisions in patients with melanoma. Superparamagnetic iron oxide nanoparticles (SPIO) combined with MRI have emerged as an alternative to Technetium lymphoscintigraphy for preoperative mapping of SLN, however, the MRI protocols so far are extensive with long in-camera time. This study aimed to evaluate an optimized MRI protocol for rapid identification of SLNs using SPIO as a tracer, without compromising diagnostic quality, the GOthenburg Fast Acquisition Sentinel lymph node Tracking MRI (GO-FAST-MRI).
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!