An investigation of the relationship between the findings on sentinel node scintigraphy and biopsy histology results in breast cancer patients.

Abstract

Introduction With the introduction of the concept of the orderly progression of lymph node metastases, breast cancer management has dramatically evolved towards minimally invasive approaches. The sentinel lymph node biopsy (SLNB) is rapidly emerging as the technique for axillary staging in breast cancer by limiting the dissection based on the status of the sentinel node/s (SN). Available evidence suggests that malignant disease primarily affects the sentinel node/s before being disseminated into the axillary nodes (ALNs). The limited removal of the axillary node/s may be improved when SN scintigraphy using the cutaneous (subdermal) peri-areolar approach, is performed. Objectives The objective of this study was to define the role of SN scintigraphy in the identification of SNs during SLNB. An additional objective was to investigate if the identified SNs are predictive of the presence or absence of metastases in the axillary lymph node basin. Methodology A quantitative approach was chosen for this non-experimental, correlation type of study. A total of 55 female breast cancer patients (mean age, 58.35 years) who were diagnosed between May 2009 and December 2010, were enrolled in this study. SN scintigraphy was perfom1ed using 15-25MBq of radiopharmaceutical enabling the skin overlying the SN to be marked to visually direct the surgeon to the sentinel node. All patients underwent SLNB with partial or total back-up axillary node dissection (ALND). Results Sentinel node/s were visualised on SN scintigraphy in 52 out of 55 patients (mean, 1.20). Successful scintigraphy was highly predictive (100%) of a successful SLNB. Results also showed a significant association (80.76%) (p :S 0.05) between the concordance of the histological status of SNs and ALNs with a quite high false-negative rate of37.5%. Conclusion On the basis of the findings of this preliminary evaluation of the local introduction of the SLNB procedure, for optimal results breast cancer patients should not be denied the benefits of SLNB preceded by routine SN scintigraphy.