Impact of Axillary Nodal Metastases on Lymphatic Mapping and Sentinel Lymph Node Identification Rate in Patients with Early Stage Breast Cancer

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2005 Apr 20

PMID 15838690

Citations 9

Authors

Ettore Pelosi

Ada Ala

Marilena Bello

Anastasios Douroukas

Giuseppe Migliaretti

Ester Berardengo

Teresio Varetto

Riccardo Bussone

Gianni Bisi

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to define the impact of the presence of axillary nodal metastases on lymphatic mapping and sentinel lymph node (SLN) identification rate in patients with early breast cancer.

Methods: Two hundred and forty-six lymphatic mapping procedures were performed with both labelled nanocolloid and blue dye, followed by SLN biopsy and/or complete axillary dissection. The following parameters were recorded: patient's age, tumour laterality and location, tumour size, tumour histology, tumour stage, tumour grade, lymphovascular invasion, radiotracer injection site (subdermal-peritumoural/peri-areolar), SLN visualisation at lymphoscintigraphy, SLN metastases (presence/absence, size) and other axillary metastases (presence/absence, number). Discriminant analysis was used to analyse the data.

Results: SLNs were identified by labelled nanocolloid alone in 94.7% of tumours, by blue dye alone in 93.5% and by the combined technique in 99.2%. Discriminant analysis showed the gamma probe SLN identification rate to be significantly limited by the presence of axillary nodal metastases. In particular, the size of SLN metastases and the number of other axillary metastases were the most important variables in reducing the gamma probe SLN identification rate (p = 0.004 and p = 0.002, respectively). On the other hand, high tumour grade was the only parameter limiting the blue dye SLN identification rate.

Conclusion: The accuracy of lymphatic mapping with labelled nanocolloid is limited by the presence of axillary nodal metastases, and particularly by the degree of SLN tumoural invasion and the presence and number of other axillary nodal metastases. Neither of these elements seems to interfere with the blue dye identification rate. The combination of the two tracers maximises the SLN identification rate.

Citing Articles

Quantum dot-NanoLuc bioluminescence resonance energy transfer enables tumor imaging and lymph node mapping in vivo.

Kamkaew A, Sun H, England C, Cheng L, Liu Z, Cai W Chem Commun (Camb). 2016; 52(43):6997-7000.

PMID: 27157466 PMC: 4912020. DOI: 10.1039/c6cc02764d.

Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial.

Straver M, Meijnen P, van Tienhoven G, van de Velde C, Mansel R, Bogaerts J Ann Surg Oncol. 2010; 17(7):1854-61.

PMID: 20300966 PMC: 2889289. DOI: 10.1245/s10434-010-0945-z.

In vivo imaging of sentinel nodes using fluorescent silica nanoparticles in living mice.

Jeon Y, Kim Y, Choi K, Piao J, Quan B, Lee Y Mol Imaging Biol. 2009; 12(2):155-62.

PMID: 19830500 DOI: 10.1007/s11307-009-0262-8.

The sentinel node in breast cancer.

Collins C Cancer Imaging. 2008; 8 Spec No A:S10-8.

PMID: 18852076 PMC: 2582497. DOI: 10.1102/1470-7330.2008.9003.

Impact of patient- and disease-specific factors on SLNB in breast cancer patients. Are current guidelines justified?.

Bembenek A, Fischer J, Albrecht H, Kemnitz E, Gretschel S, Schneider U World J Surg. 2006; 31(2):267-75.

PMID: 17180478 DOI: 10.1007/s00268-005-0720-7.

References

Kern K . Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye. J Am Coll Surg. 1999; 189(6):539-45. DOI: 10.1016/s1072-7515(99)00200-8. View

Tanis P, van Sandick J, Nieweg O, Valdes Olmos R, Rutgers E, Hoefnagel C . The hidden sentinel node in breast cancer. Eur J Nucl Med Mol Imaging. 2002; 29(3):305-11. DOI: 10.1007/s00259-001-0732-y. View

Cox C, Bass S, McCann C, Ku N, BERMAN C, Durand K . Lymphatic mapping and sentinel lymph node biopsy in patients with breast cancer. Annu Rev Med. 2000; 51:525-42. DOI: 10.1146/annurev.med.51.1.525. View

Miltenburg D, Miller C, Karamlou T, Brunicardi F . Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res. 1999; 84(2):138-42. DOI: 10.1006/jsre.1999.5629. View

Guenther J . Axillary dissection after unsuccessful sentinel lymphadenectomy for breast cancer. Am Surg. 1999; 65(10):991-4. View

Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M . Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997; 349(9069):1864-7. DOI: 10.1016/S0140-6736(97)01004-0. View

Klimberg V, Rubio I, Henry R, Cowan C, Colvert M, Korourian S . Subareolar versus peritumoral injection for location of the sentinel lymph node. Ann Surg. 1999; 229(6):860-4; discussion 864-5. PMC: 1420833. DOI: 10.1097/00000658-199906000-00013. View

Hill A, Tran K, Akhurst T, Yeung H, Yeh S, Rosen P . Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg. 1999; 229(4):528-35. PMC: 1191739. DOI: 10.1097/00000658-199904000-00012. View

Cox C, Dupont E, Whitehead G, Ebert M, Nguyen K, Peltz E . 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(2):88-91. DOI: 10.1046/j.1524-4741.2002.08203.x. View

10.

Pelosi E, Bello M, Giors M, Ala A, Giani R, Bussone R . Sentinel lymph node detection in patients with early-stage breast cancer: comparison of periareolar and subdermal/peritumoral injection techniques. J Nucl Med. 2004; 45(2):220-5. View

11.

Borgstein P, Meijer S, Pijpers R, van Diest P . Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg. 2000; 232(1):81-9. PMC: 1421111. DOI: 10.1097/00000658-200007000-00012. View

12.

Tanis P, Nieweg O, Valdes Olmos R, Kroon B . Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg. 2001; 192(3):399-409. DOI: 10.1016/s1072-7515(00)00776-6. View

13.

Ahrendt G, Laud P, Tjoe J, Eastwood D, Walker A, Otterson M . Does breast tumor location influence success of sentinel lymph node biopsy?. J Am Coll Surg. 2002; 194(3):278-84. DOI: 10.1016/s1072-7515(01)01174-7. View

14.

Albertini J, Lyman G, Cox C, Yeatman T, Balducci L, Ku N . Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996; 276(22):1818-22. View

15.

Brenot-Rossi I, Houvenaeghel G, Jacquemier J, Bardou V, Martino M, Hassan-Sebbag N . Nonvisualization of axillary sentinel node during lymphoscintigraphy: is there a pathologic significance in breast cancer?. J Nucl Med. 2003; 44(8):1232-7. View

16.

Krausz Y, Ikeda D, Jadvar H, Langleben D, Birdwell R, Strauss H . Non-visualization of sentinel lymph node in patients with breast cancer. Nucl Med Commun. 2001; 22(1):25-32. DOI: 10.1097/00006231-200101000-00004. View

17.

Giuliano A, Dale P, Turner R, Morton D, Evans S, Krasne D . Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg. 1995; 222(3):394-9; discussion 399-401. PMC: 1234825. DOI: 10.1097/00000658-199509000-00016. View

18.

Borgstein P, Pijpers R, Comans E, van Diest P, Boom R, Meijer S . Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg. 1998; 186(3):275-83. DOI: 10.1016/s1072-7515(98)00011-8. View

19.

Wu C, Morita E, Treseler P, Esserman L, Hwang E, Kuerer H . Failure to harvest sentinel lymph nodes identified by preoperative lymphoscintigraphy in breast cancer patients. Breast J. 2003; 9(2):86-90. DOI: 10.1046/j.1524-4741.2003.09205.x. View

20.

McMasters K, Tuttle T, Carlson D, Brown C, Noyes R, Glaser R . Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol. 2000; 18(13):2560-6. DOI: 10.1200/JCO.2000.18.13.2560. View