Original Scientific Articles
Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy☆

https://doi.org/10.1016/S1072-7515(98)00306-8Get rights and content

Abstract

Background: Radiolocalization and selective biopsy of the sentinel node to correctly predict the status of remaining lymph nodes may provide an alternative to axillary dissection in selected breast cancer patients with clinically negative lymph nodes.

Study Design: In a nonrandomized, multicenter clinical trial, gamma probe localization for lymphatic mapping and sentinel node biopsy along with axillary dissection was performed on 75 patients with invasive breast cancer and clinically negative lymph nodes. The accuracy of the sentinel node biopsy to correctly predict the status of the remaining axillary lymph nodes was established through standard pathologic investigation.

Results: A sentinel node was identified in 70 of 75 patients with a technical success rate of 93%. Of these 70 patients, 21 (30%) had axillary nodal metastases identified pathologically. Four of these 21 (19%) had sentinel nodes negative for metastases. All 4 false-negative patients had prior excisional biopsies. The false-negative group had a larger mean maximal biopsy dimension than the true-positive group. Eleven of the 21 patients with axillary metastases had a diagnosis made by core needle biopsy with no false negatives.

Conclusions: The accuracy of the sentinel node biopsy in correctly predicting the status of remaining axillary lymph nodes may be limited in patients with large excision before radiolocalization of the sentinel node. Our findings suggest that excisional biopsy should be avoided prior to lymphatic mapping for sentinel node biopsy.

Section snippets

Methods

Two groups of patients were included in the study and were designated Phase I (57 patients) and Phase II (18 patients) for a total of 75 patients. All patients in Phase I and Phase II were seen at Benedictine Hospital. Phase I patients were part of the National Cancer Institute (NCI) Prospective Multi-Center Trial; Phase II patients were not enrolled in the NCI Trial. Standard operative consent forms were used for Phase II patients without additional institutional review board approval.

The 57

Results

Sentinel node(s) were identified in 70 of 75 study participants with a technical success rate of 93%. There were 74 females and 1 male. The mean age was 59.1 years (range 25 to 84 years). All participants had invasive carcinoma with 81% ductal, 4% lobular, 4% mixed, and 11% other types. The mean tumor size was 1.9 ± 1.0 cm. Seventy-three percent of the patients were treated with partial mastectomy and 27% by modified radical mastectomy. The mean time between isotope injection and surgery was

Discussion

Sentinel node biopsy has been proposed to be of sufficient accuracy to preclude full axillary dissection.5 Our findings indicate that there may a subset of patients in whom a histologically negative sentinel biopsy does not rule out the presence of malignancy in the remaining axillary nodes. Specifically out of 70 patients in whom a sentinel node was identified, 4 had no malignancy seen in the sentinel node but had malignancy identified in nonsentinel nodes. Table 3 reviews in detail the

Acknowledgements

National Cancer Institute; Nuclear Medicine Department; Radiology staff and nurses; operating room team, Benedictine Hospital; Benedictine Health Foundation; Histology Department, Kingston Benedictine Hospitals Laboratory; Fern Feldman Anolick Breast Center.

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Grant Support: Milstein Family Foundation, Jacob and Sophie Rice Family Foundation, Charles and Mildred Schnurmacher Foundation. David Krag, MD, has served within the past 3 years as a consultant to Care Wise Medical Products Corp.

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