RSS-Feed abonnieren

DOI: 10.4103/wjnm.wjnm_32_18
Triple-site radiotracer application in breast lymphoscintigraphy and sentinel node discordance

Abstract
Sentinel lymph node (SLN) biopsy (SLNB) has demonstrated accuracy in the axillary staging of breast cancer patients. Despite variability in selection criteria and technique, an SLN is consistently identified in approximately 96% of cases and in most series predicts the status of remaining axillary LNs in >95% of cases. The false-negative rate of sentinel lymph node biopsy (SLNB) was originally reported as 5%–10% (sensitivity 90%–95%), but improved rates are attainable by experienced surgeons. Radiolocalization with lymphoscintigraphy (LSG) increases SLN identification rates. LSG is a useful tool to establish the abnormal lymphatic drainage patterns and to detect the extra-axillary nodes, particularly internal mammary nodes. Despite controversy regarding the optimal injection method, studies have generally suggested high concordance between the various radiotracer application sites and axillary SLN identification. Discordant SLN identification would have implications for nodal staging as the true SLN might not be identified with individual injection techniques. In the current study, imaging from consecutive patients presenting for breast LSG over a-19 month period was retrospectively reviewed. Radiotracer application was performed with simultaneous injection of peritumoral, subcutaneous, and subareolar regions. This application method provided a mechanism to assess the LSG drainage patterns with a view to assessing injection site concordance and SLN identification rates. Data from 123 breast LSG patients were reviewed. Using our radiotracer technique, the axillary SLN identification rate was 98%. A single axillary node was detected in 110, two axillary nodes were detected in 10, and no axillary node was detected in three patients. Among those 10 patients in whom two axillary nodes were seen, at least two cases of discordant drainage occurred from different injection sites. This study demonstrates that different LSG injection sites can result in the identification of different axillary sentinel nodes although this appears to be a rare event. This finding may be of clinical importance if the true SLN is sought. In addition, the multisite injection technique appears to be an optimal method of axillary SLN identification, with high SLN detection rates.
Keywords
Breast lymphoscintigraphy - breast surgery - neoplasm staging - sentinel lymph node biopsy - surgical oncologyFinancial support and sponsorship
Nil.
Publikationsverlauf
Eingereicht: 00. 00 2019
Angenommen: 00. 00 2019
Artikel online veröffentlicht:
22. April 2022
© 2019. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Mabry H, Giuliano AE. Sentinel node mapping for breast cancer: Progress to date and prospects for the future. Surg Oncol Clin N Am 2007;16:55-70.
- 2 Straver ME, Meijnen P, van Tienhoven G, van de Velde CJ, Mansel RE, Bogaerts J, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol 2010;17:1854-61.
- 3 Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, et al. Sentinel lymph node biopsy in breast cancer: Ten-year results of a randomized controlled study. Ann Surg 2010;251:595-600.
- 4 He PS, Li F, Li GH, Guo C, Chen TJ. The combination of blue dye and radioisotope versus radioisotope alone during sentinel lymph node biopsy for breast cancer: A systematic review. BMC Cancer 2016;16:107.
- 5 Donegan WL. Tumor-related prognostic factors for breast cancer. CA Cancer J Clin 1997;47:28-51.
- 6 Jatoi I, Hilsenbeck SG, Clark GM, Osborne CK. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol 1999;17:2334-40.
- 7 Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: Update of a randomised controlled study. Lancet Oncol 2006;7:983-90.
- 8 Chong C, Walters D, de Silva P, Taylor C, Spillane A, Kollias J, et al. Initial axillary surgery: Results from the BreastSurgANZ quality audit. ANZ J Surg 2015;85:777-82.
- 9 Torrenga H, Meijer S, Fabry H, van der Sijp J. Sentinel node biopsy in breast cancer patients: Triple technique as a routine procedure. Ann Surg Oncol 2004;11:231S-5S.
- 10 Syme DB, Collins JP, Mann GB. Comparison of blue dye and isotope with blue dye alone in breast sentinel node biopsy. ANZ J Surg 2005;75:817-21.
- 11 Cody HS 3rd, Fey J, Akhurst T, Fazzari M, Mazumdar M, Yeung H, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: Univariate and multivariate analysis of 966 procedures. Ann Surg Oncol 2001;8:13-9.
- 12 Teal CB, Slocum JP, Akin EA. Evaluation of the benefit of using blue dye in addition to radioisotope for sentinel lymph node biopsy in patients with breast cancer. Breast J 2005;11:391-3.
- 13 Krynyckyi BR, Kim CK, Goyenechea MR, Chan PT, Zhang ZY, Machac J, et al. Clinical breast lymphoscintigraphy: Optimal techniques for performing studies, image atlas, and analysis of images. Radiographics 2004;24:121-45.
- 14 Paganelli G, Galimberti V, Trifirò G, Travaini L, De Cicco C, Mazzarol G, et al. Internal mammary node lymphoscintigraphy and biopsy in breast cancer. Q J Nucl Med 2002;46:138-44.
- 15 Krynyckyi BR, Chun H, Kim HH, Eskandar Y, Kim CK, Machac J, et al. Factors affecting visualization rates of internal mammary sentinel nodes during lymphoscintigraphy. J Nucl Med 2003;44:1387-93.
- 16 Pelosi E, Bellò M, Giors M, Ala A, Giani R, Bussone R, et al. Sentinel lymph node detection in patients with early-stage breast cancer: Comparison of periareolar and subdermal/peritumoral injection techniques. J Nucl Med 2004;45:220-5.
- 17 Lin KM, Patel TH, Ray A, Ota M, Jacobs L, Kuvshinoff B, et al. Intradermal radioisotope is superior to peritumoral blue dye or radioisotope in identifying breast cancer sentinel nodes. J Am Coll Surg 2004;199:561-6.
- 18 Johnson CB, Boneti C, Korourian S, Adkins L, Klimberg VS. Intraoperative injection of subareolar or dermal radioisotope results in predictable identification of sentinel lymph nodes in breast cancer. Ann Surg 2011;254:612-8.
- 19 Krynyckyi BR, Miner M, Ragonese JM, Firestone M, Kim CK, Machac J, et al. Technical aspects of performing lymphoscintigraphy: Optimization of methods used to obtain images. Clin Nucl Med 2000;25:978-85.
- 20 Sanli Y, Berberoglu K, Turkmen C, Ozmen V, Muslumanoglu M, Igci A, et al. The value of combined peritumoral and subdermal injection techniques for lymphoscintigraphy in detection of sentinel lymph node in breast cancer. Clin Nucl Med 2006;31:690-3.
- 21 Celliers L, Mann GB. Alternative sites of injection for sentinel lymph node biopsy in breast cancer. ANZ J Surg 2003;73:600-4.
- 22 Borgstein PJ, Meijer S, Pijpers R. Intradermal blue dye to identify sentinel lymph-node in breast cancer. Lancet 1997;349:1668-9.
- 23 Klimberg VS, Rubio IT, Henry R, Cowan C, Colvert M, Korourian S, et al. Subareolar versus peritumoral injection for location of the sentinel lymph node. Ann Surg 1999;229:860-4.
- 24 Ahmed M, Purushotham AD, Horgan K, Klaase JM, Douek M. Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer. Br J Surg 2015;102:169-81.
- 25 Mariani G, Erba P, Villa G, Gipponi M, Manca G, Boni G, et al. Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: The nuclear medicine perspective. J Surg Oncol 2004;85:112-22.
- 26 Nieweg OE, Jansen L, Valdes Olmos RA, Rutgers EJ, Peterse JL, Hoefnagel KA, et al. Lym-phatic mapping and sentinel lymph node biopsy in breast cancer. Eur J Nuc Med 1999;26:S11-6.
- 27 Pritsivelis C, Garcia Mendonça CA, Pinheiro Pessoa MC, Coelho-Oliveira A, Gutfilen B, Barbosa Da Fonseca LM, et al. Failure predictors of the sentinel lymph node in patients with breast cancer using Tc-99m sulfur colloid and periareolar injection. Q J Nucl Med Mol Imaging 2007;51:189-93.
- 28 Krausz Y, Ikeda DM, Jadvar H, Langleben D, Birdwell R, Strauss HW, et al. Non-visualization of sentinel lymph node in patients with breast cancer. Nucl Med Commun 2001;22:25-32.
- 29 Cox CE, Dupont E, Whitehead GF, Ebert MD, Nguyen K, Peltz ES, et al. Age and body mass index may increase the chance of failure in sentinel lymph node biopsy for women with breast cancer. Breast J 2002;8:88-91.
- 30 Lamonica D, Edge SB, Hurd T, Proulx G, Stomper PC. Mammographic and clinical predictors of drainage patterns in breast lymphoscintigrams obtained during sentinel node procedures. Clin Nucl Med 2003;28:558-64.
- 31 Rodriguez Fernandez J, Martella S, Trifirò G, Caliskan M, Chifu C, Brenelli F, et al. Sentinel node biopsy in patients with previous breast aesthetic surgery. Ann Surg Oncol 2009;16:989-92.
- 32 Shimazu K, Tamaki Y, Taguchi T, Motomura K, Inaji H, Koyama H, et al. Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer. Ann Surg 2003;237:390-8.
- 33 Manca G, Volterrani D, Mazzarri S, Duce V, Svirydenka A, Giuliano A, et al. Sentinel lymph node mapping in breast cancer: A critical reappraisal of the internal mammary chain issue. Q J Nucl Med Mol Imaging 2014;58:114-26.
- 34 Canavese G, Gipponi M, Catturich A, Di Somma C, Vecchio C, Rosato F, et al. Pattern of lymphatic drainage to the sentinel lymph node in breast cancer patients. J Surg Oncol 2000;74:69-74.
- 35 Hindié E, Groheux D, Hennequin C, Zanotti-Fregonara P, Vercellino L, Berenger N, et al. Lymphoscintigraphy can select breast cancer patients for internal mammary chain radiotherapy. Int J Radiat Oncol Biol Phys 2012;83:1081-8.
- 36 Roumen RM, Geuskens LM, Valkenburg JG. In search of the true sentinel node by different injection techniques in breast cancer patients. Eur J Surg Oncol 1999;25:347-51.
- 37 Fregnani J, Macea J. Lymphatic drainage of the breast: From theory to surgical practice. Int J Morphol 2009;27:873-8.
- 38 Tuttle TM, Zogakis TG, Dunst CM, Zera RT, Singletary SE. A review of technical aspects of sentinel lymph node identification for breast cancer. J Am Coll Surg 2002;195:261-8.