Gamma probe-guided sentinel node biopsy—optimal timing for injection

doi:10.1016/S0748-7983(98)93392-3

European Journal of Surgical Oncology (EJSO)

Volume 24, Issue 6, December 1998, Pages 515-519

https://doi.org/10.1016/S0748-7983(98)93392-3 Get rights and content

Aims.

We initiated a Phase I feasibility study using a gamma-detecting probe (GDP) and radiolabelled colloid to localize the sentinel lymph node (SLN) in breast cancer. The aim of the study was to establish the ideal timing for injection and examine any possible exclusion criteria for this method.

Methods.

Thirty breast cancer patients diagnosed by fine needle aspiration (FNA) were included in this study. All were injected with 60 M Bq rhenium colloid labelled with ^99mTc (Tck-17). Scintigraphy was done 20 min, 2, 6 and 25 hours post-injection. Patients were then taken to surgery where they were injected with patent blue dye. During surgery, the SLN was located with a GDP (Neoprobe^® Model 1000). In 28 patients, the SLN was identified by scintigraphy 2 hours after injection, identical to the images seen after 24 hours.

Results.

In all 28 patients, the SLN was found by the GDP during surgery. In 26 patients the SLN was dyed blue. The two patients with no SLN localization had received prior radiation. Pathology disclosed SLNs with metastases in seven patients. Two patients had a negative SLN but had an axillary lymph node replaced by tumour.

Conclusions.

Two to 24 hours prior to surgery is suitable timing for injection. Previous radiotherapy predicts failure for this procedure. Further studies are needed to find the exact false-negative rate of this method for breast cancer.

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To analyse causes of failure of sentinel node (SN) procedures in breast cancer patients and assess the role of pre-operative ultrasound examination of the axilla.
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In 53/138 patients, the SN was positive for tumour. Full axillary node dissection revealed that 58/138 were node positive. So in five patients the SN failed to predict true nodal status. In 3/5, the radioactive ratio (SN vs background) was inadequate. All were found to have extensive nodal involvement. The radioactivity ratio was inadequate in 37/138 patients. This ratio was inadequate in 10 of 15 patients with ≥4 positive nodes and 27 of 123 in patients with 0–3 positive nodes (p<0.001). If extranodal growth was present the radioactive ratio was inadequate in 13 of 18 patients, whilst this was only the case in 24 of 120 patients without extranodal growth or metastases (p<0.001). Ultrasound (US) examination and US-guided FNAC was able to pre-operatively identify 16 of the 26 patients with four or more metastases in the axilla.
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Recently, sentinel lymph node (SLN) biopsy has been employed to avoid unnecessary lymph node dissection, because SLN negativity for carcinoma metastases may imply an extremely low possibility of non-SLN involvement. Pathological evaluation is essential, but standardized procedures have not yet been determined. Intraoperative consultation, either by frozen section (multiple slices are desirable) or touch imprint cytology, are usually very useful. Their accuracy, however, is variable and depends on the procedures used, but specificity is characteristically 100%, and the missed metastatic focus is always quite minute. After fixation, multiple sections, immuno-histochemistry, and their combination will be able to detect small metastatic foci more frequently. The clinical significance of small or submicro- or occult metastases have not yet been clarified, and further investigations are needed. If the SLN is positive for carcinoma metastases, both the procedure for detection and the size of the metastatic focus should be clarified on the pathological reports.
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Original articleGamma probe-guided sentinel node biopsy—optimal timing for injection

Aims.

Methods.

Results.

Conclusions.

Lancet

Ann Vasc Surg

Monthly Epidemiol Record

Technical details of intraoperative lymphatic mapping for early stage melanoma

Arch Surg

Surgical resection and radiolocalization of sentinel lymph node in breast cancer using a gamma probe

SSO Abstract Book

Lymphatic mapping and sentinel lymphadenectomy for breast cancer

Ann Surg

Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy

Br J Surg

Lymphoscintigraphy, lymphatic mapping and sentinel node biopsy in melanoma patients using a single dose of 99mTc-colloid

Lymphography of the breast as an accessory in the early diagnosis and detection of carcinoma of the breast: lymphography as a prognostic tool

World J Surg

Axillary lymph nodes and breast cancer

Cancer

Original article
Gamma probe-guided sentinel node biopsy—optimal timing for injection

Lymphoscintigraphy, lymphatic mapping and sentinel node biopsy in melanoma patients using a single dose of ^99mTc-colloid