Value of preoperative lymphoscintigraphy in sentinel lymph node biopsy of breast cancer

Objectives Background Although preoperative lymphoscintigraphy for sentinel lymph nodes biopsy (SLNB) in breast cancer patients is undergone commonly, its clinical significance remains controversial. Methods Firstly, a database containing 716 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB was retrospectively analyzed. Secondly, 565 consecutive breast cancer patients were prospectively randomized into groups with or without preoperative lymphoscintigraphy before SLNB. Results In the retrospective study, sentinel lymph nodes (SLNs) were well imaged by lymphoscintigraphy in 86.6% patients, and negative lymphoscintigraphy results were associated with axillary node metastases. Failure of identification of SLNs by isotope alone was associated with whether axillary hot spot was imaged by lymphoscintigram (P0.001). There were no significant differences in the false negative rate (P=0.731) of SLNB by isotope alone, in the identification rate (P=0.174) and the false negative rate (P=0.947) of SLNB by combination of dye and isotope between patients who had axillary hot spot in lymphoscintigram and those who had not. In the prospective study, 290 patients were randomized into the group with preoperative lymphoscintigraphy (82.1% patients were well imaged by lymphoscintigraphy) and 275 patients without. There were no significant differences between two groups in the identification rate (P=0.757) and the false negative rate (P=1.00) of SLNB by isotope alone, also in the identification rate (P=1.00) and the false negative rate (P=1.00) of SLNB by combination of dye and isotope. Conclusion Preoperative lymphoscintigraphy could not improve the identification rate and reduce the false negative rate of SLNB in breast cancer patients, and it is not a prerequisite for SLNB.