Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical

TY - JOUR

T1 - Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical

AU - Nielsen, Kristina R

AU - Oturai, Peter S

AU - Friis, Esbern

AU - Hesse, Ulrik

AU - Callesen, Torben

AU - Nielsen, Michael B

AU - Chakera, Annette H

AU - Hesse, Birger

N1 - © 2011 The Authors. Clinical Physiology and Functional Imaging © 2011 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

PY - 2011/7

Y1 - 2011/7

N2 - Background: The radioactivity present in the patient (Act rem) at sentinel node (SN) biopsy will depend on injected activity amount as well as on the time interval from tracer injection to biopsy, which both show great variations in the literature. The purpose of this study was to analyse the influence of varying Act rem levels on the outcome of axillary SN biopsy in patients with breast cancer (BC). Material and methods: Eight hundred and fifty-eight patients with BC were consecutively referred to SN biopsy, 21% for a same-day and 79% of the patients for a 2-day procedure. Four hundred and nineteen patients underwent scintigraphy and 439 did not. For same-day procedures, 50MBq 99mTc-nanocolloid (Nanocoll ®) was injected, and for 2-day procedures 110MBq. For the analysis of SN biopsy outcome, the patients were divided into three Act rem groups: <10 (56% of the patients), 10-20 (23%), and >20MBq (21%). During surgery, SNs were located using a hand-held gamma probe supported by image information when available and blue dye injection. Pathology included haematoxylin-eosin staining followed by immunohistochemistry. Results: The number of SNs removed (mean value 1·87 versus 2·14, P=0·0003) and the probability of finding a malignant SN (P=0·034) were lower in the <10MBq group of patients compared with higher Act rem >20MBq. Of the 25 patients with SN non-detection, 20 patients had an Act rem <10MBq. Imaging had no significant influence on the number of patients with a malignant SN (P=0·48). Conclusion: Act rem above 10MBq for nanocolloid tracer appears important for appropriate identification of SNs in patients with BC.

AB - Background: The radioactivity present in the patient (Act rem) at sentinel node (SN) biopsy will depend on injected activity amount as well as on the time interval from tracer injection to biopsy, which both show great variations in the literature. The purpose of this study was to analyse the influence of varying Act rem levels on the outcome of axillary SN biopsy in patients with breast cancer (BC). Material and methods: Eight hundred and fifty-eight patients with BC were consecutively referred to SN biopsy, 21% for a same-day and 79% of the patients for a 2-day procedure. Four hundred and nineteen patients underwent scintigraphy and 439 did not. For same-day procedures, 50MBq 99mTc-nanocolloid (Nanocoll ®) was injected, and for 2-day procedures 110MBq. For the analysis of SN biopsy outcome, the patients were divided into three Act rem groups: <10 (56% of the patients), 10-20 (23%), and >20MBq (21%). During surgery, SNs were located using a hand-held gamma probe supported by image information when available and blue dye injection. Pathology included haematoxylin-eosin staining followed by immunohistochemistry. Results: The number of SNs removed (mean value 1·87 versus 2·14, P=0·0003) and the probability of finding a malignant SN (P=0·034) were lower in the <10MBq group of patients compared with higher Act rem >20MBq. Of the 25 patients with SN non-detection, 20 patients had an Act rem <10MBq. Imaging had no significant influence on the number of patients with a malignant SN (P=0·48). Conclusion: Act rem above 10MBq for nanocolloid tracer appears important for appropriate identification of SNs in patients with BC.

U2 - 10.1111/j.1475-097x.2011.01015.x

DO - 10.1111/j.1475-097x.2011.01015.x

M3 - Journal article

SN - 1475-0961

VL - 31

SP - 288

EP - 293

JO - Clinical Physiology and Functional Imaging

JF - Clinical Physiology and Functional Imaging

IS - 4

ER -