Lymphoscintigraphy to identify sentinel lymph node in the treatment of breast cancer

Objective To assess the value of lymphoscintigraphy and gamma detector porbe in identifying sentinel lymph node in breast cancer,and verify the safety and value of sentinel lymph node biopsy to replace axillary lymph node dissection in breast cancer treatment.Methods Between June 1999 and November 2009,206 patients with operable invasive breast cancer and clinically proved negative axillary lymph nodes were included in the study.The 99Tcm-dextran of 37-74 MBq or/and patent blue dye were injected subdermally around the primary tumor.Lymphoscintigraphy and gamma detector porbe were used to detect the sentinel lymph node(SLN),and then compared with introperative frozen pathology results.If intraoperative frozen sentinel lymph node metastasis was found,axillary lymph node dissection was performed.If the sentinel lymph node was negative,axillary lymph node dissection was not needed.Patients were followed up regularly after operation.Result SLN was identified in 204 of the 206 breast cancer patients,with the success rate of 99.0%.In this group 64 cases had SLN resection,and postoperative pathological examination confirmed that their SLN were negative,so they did not have axillary lymph node dissection.Axillary lymph node metastasis occurred in one of the 64 cases one year after operation,and the rest 63 cases were not found with axillary lymph node metastasis or ipsilateral upper extremity edema or abnormal sense during follow-up.The 140 cases had routine axillary lymph node dissection,6 of them were confirmed pathologically with positive SLN but negative axillary lymph nodes,and in the rest 134 cases,pathologically positive SLN was in 35 patients and negative SLN in 99 cases;and pathologically positive axillary lymph node in 37 cases and negative in 97 cases.The sensitivity and the accuracy of lymphoscintigraphy and gamma detector porbe in identifying SLN and the metastasis of axillary lymph node was 94.6%(35/37 cases) and 98.5%(138/140 cases),respectively;the false-negative rate was 5.4%(2/37).Conclusion Lymphoscintigraphy and the gamma detector probe for detecting SLN is feasible in breast cancer patients and has clinical applicable value in predicting axillary lymph node metastasis.It is a well established technique.Early breast cancer sentinel lymph node biopsy can replace the conventional axillary lymph node dissection,and the incidence of surgical complications in upper limb can be greatly reduced for breast cancer patients.