Purpose:To evaluate the performance and feasibility of sentinel node biopsy (SNB) in breast cancer patients using 99mTc Sulphur colloid and gamma probe.Methods:At Cancer Hospital,from May 2000 30 patients with tumor less than 5 cm with clinically negative axilla underwent SNB, which is followed by standard axillary dissection. 99mTc sulphur colloid was injected around the breast tumor and gamma probe was used to detect the SLN during surgery. SNB is compared with standard axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes.Results:The sentinel node is successfully identified in 90% (27/30) of the patients. Number of sentinel nodes ranged from 1—3,average 1.5, nonsentinael nodes 5—20,average 13.3 per patient. Of the 27 patients 52%(14/27) were histologically positive. The sentinel node was falsely negative in 2 patients, yielding an accuracy of 92.6%. In T 1 tumors, SNB was more accurate than for T 2 tumors.Conclusions:Gamma probe guided method is technically feasible in detecting sentinel nodes in most cases and predicts the axillary status quite accurately, and appears to be more accurate for T 1 lesions than for larger lesions. This minimally invasive axillary staging procedure represents a major advance in the surgical treatment of breast cancer.

OBJECTIVETo evaluate the accuracy of sentinel lymph node biopsy (SLNB) to predict the axillary lymph node status in breast cancer patients and its clinical significance.

METHODSSeventy patients with clinical TNM status T(1 - 2)N(0)M(0) underwent sentinel lymph node biopsy using Tc-99m sulfur colloid radiotracer and gamma probe, which was followed by standard axillary dissection. SLNB was compared with standard axillary dissection for its ability to reflect the final pathological status of the axillary nodes. The SLNs that were tumor negative in conventional HE staining were further evaluated using immunohistochemical stains for CK8, CK19 and KP-1 antibodies.

RESULTSThe sentinel lymph node (SLN) was successfully identified in 67 (95.7%) out of 70 patients. The number of sentinel nodes harvested ranged from 1 to 5 (average 1.6). The nonsentinel nodes ranged from 5 to 20 (average 12.3). Of the 67 patients, 29 (43.3%) had histologically positive axillary lymph nodes. SLN was positive in 24 patients with metastasis (35.8%), and in 7 patients without metastasis (10.4%). In 5 patients, SLN was negative for tumor with positive nodes. The accuracy of sentinel lymph node biopsy to predict the axillary lymph node status was 92.5% and the false negative rate was 7.5%. For tumors with diameter less than or equal to 2 cm, the accuracy was 100%. 65 SLNs that were negative for HE stain were also non-reactive to immunostain for CK8 and CK19 antibody.

CONCLUSIONSSLNB can accurately predict the axillary lymph node status in most of breast cancer patients. The accuracy is about 100% in patients with T(1) lesions. Immunohistochemical staining at the same level of HE stain can not increase the detection of lymph node micrometastasis.

Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms ; pathology ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Sentinel Lymph Node Biopsy

OBJECTIVETo evaluate the feasibility of lymphoscintigraphy in sentinel lymph node biopsy of breast cancer.

METHODLymphoscintigraphy was performed after peritumoral or subdermal injection of radioactive colloid. Then, sentinel lymph node (SLN) biopsy guided by gamma detector probe was performed. Factors correlated with identification-detection rate were assessed.

RESULTSLymphatic drainage was present in preoperative lymphoscintigraphy in 88(93%) out of 95 patients, with 39 (44.3%) positive for lymphatic drainage other than in the axilla. A total of 91 (95.8%) patients had their SLN identified in the intraoperative procedure. The quality of lymphoscintigraphic image was closely related to SLN identification-detection rate in the intraoperative procedure (P = 0.025).

CONCLUSIONSentinel lymph node outside the axilla can be detected by lymphoscintigraphy. The combination of lymphoscintigraphy and gamma detector probe for sentinel lymph node biopsy of breast cancer not only is acceptable but promising.

Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms ; diagnosis ; pathology ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; diagnosis ; Middle Aged ; Sentinel Lymph Node Biopsy