J Breast Cancer.  2006 Sep;9(3):235-240. 10.4048/jbc.2006.9.3.235.

The Result of Evaluation According to Radioactivity of Sequential Sentinel Nodes Biopsy in Breast cancer

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. bwpark@yumc.yonsei.ac.kr
  • 2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea.
  • 4Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Radio-guided sentinel node biopsy has become a standard method for evaluating the axillary status. However, there is no guideline for the optimum extent of sentinel lymphadenectomy. The object of this study was to assess the probability of metastases according to the sequence of radioactivity in the sentinel nodes and to determine the accuracy of the methods for evaluating metastases.
METHODS
80 consenting patients underwent sentinel lymph node biopsy using 99mTc-phytate. All the lymph nodes that showed radioactivity higher than surroundings were excised and labeled as SN1 to SN5 according to the sequential radioactivity. All the excised sentinel nodes were evaluated by frozen sectioning (FS) and permanent sectioning (PS). The sensitivity, specificity, negative predictive value and accuracy of the procedure were then analyzed according to the evaluation method.
RESULTS
All 80 patients showed a variable number of axillary sentinel node sites (SN1-SN5) and 19 patients (23.8%) had three or more sentinel node sites, with an average number of 1.98. The sensitivity, specificity, NPV and accuracy were higher on PS (94.4%, 100%, 98.4% and 98.8% respectively) than on FS (88.9%, 100%, 96.9% and 97.5% respectively). 20 patients were found to have metastatic breast cancer within the sentinel lymph nodes by IHC, but one case of a metastatic, non-sentinel node was found in the 60 patients with negative sentinel nodes, so that the final false negative rate was 4.8%. In 18 of the 20 sentinel node-positive patients(90.0%), the most radioactive lymph node (SN1) was a positive node. The removal of the most radioactive sentinel node and the 2nd most radioactive sentinel node accurately staged all 20 sentinel node-positive patients.
CONCLUSION
Careful evaluation of the sentinel nodes with FS, PS and IHC study is essential to reduce the false negative results. In addition, excision of the highest and the 2nd highest lymph nodes is essential and the excision of the 3rd highest node if any, should also be considered for obtaining a better treatment results.

Keyword

breast cancer; sentinel lymph node; sequential radioactivity

MeSH Terms

Biopsy*
Breast Neoplasms*
Breast*
Humans
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Radioactivity*
Sensitivity and Specificity
Sentinel Lymph Node Biopsy

Cited by  1 articles

How Many Sentinel Lymph Nodes Are Enough for Accurate Axillary Staging in T1-2 Breast Cancer?
Eun Jeong Ban, Jun Sang Lee, Ja Seung Koo, Seho Park, Seung Il Kim, Byeong-Woo Park
J Breast Cancer. 2011;14(4):296-300.    doi: 10.4048/jbc.2011.14.4.296.


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