Value of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Previous Excisional Biopsy

다국어 초록 (Multilingual Abstract)

Purpose: Sentinel lymph node biopsy (SLNB) in breast cancer patients with clinically negative axilla will ensure axillary dissection only for cases with lymph node metastasis and provide information about pathologic staging as accurate as the axillary dissection. It was shown that SLNB could be successfully performed regardless of the type of biopsy. The aim of this study was to investigate the feasibility of SLNB after excisional biopsy. Methods:One hundred patients diagnosed with excisional biopsy or guide wire-localization and operated on with SLNB between February 2007 and March 2009 were retrospectively analyzed. SLNB was performed with 10 cc of 1% methylene blue alone or both methylene blue and 1 mCi of Tc-99m nanocolloid combination. Age, tumor localization and size, length of the biopsy incision, size of the biopsy specimen, multifocality, lymphovascular invasion, tumor grade, staining with methylene blue, localization, number and metastatic status of the lymph nodes stained, and success rate with a gamma probe were evaluated. Results: Sentinel lymph node (SLN) could not be identified in 9 (16.9%) of patients in the methylene blue group (n=53). In the combination group (n=47), SLN could not be identified in one patient. Of 32 patients with negative SLNB, metastatic involvement was found to be present in 5 patients after axillary lymph node dissection (false negatives). The average numbers of SLNs found in the methylene blue group and combination group were 1.4 and 1.6, respectively. SLN detection and false negative rates in the methylene blue group were 83% and 15.7%, respectively. The rates for the combination group were 98% and 6.4%, respectively. None of the parameters related to patient, tumor or process were found to affect detection rates of SLN. Conclusion: Only SLNB using a combination method is a safe and reliable technique for breast cancer patients diagnosed with excisional biopsy.

참고문헌 (Reference)

1 Wong SL, "The effect of prior breast biopsy method and concurrent definitive breast procedure on success and accuracy of sentinel lymph node biopsy" 9 : 272-277, 2002

2 Krag DN, "Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically nodenegative breast cancer: results from the NSABP B-32 randomised phase III trial" 8 : 881-888, 2007

3 Ruano R, "Staging the axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer" 35 : 1299-1304, 2008

4 Nos C, "Sentinel lymph node detection for breast cancer: which patients are best suited for the patent blue dye only method of identification?" 8 : 438-443, 2001

5 O’Hea BJ, "Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center" 186 : 423-427, 1998

6 McMasters KM, "Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used" 18 : 2560-2566, 2000

7 Hung WK, "Randomized clinical trial comparing blue dye with combined dye and isotope for sentinel lymph node biopsy in breast cancer" 92 : 1494-1497, 2005

8 Rutgers EJ, "Quality control in the locoregional treatment of breast cancer" 37 : 447-453, 2001

9 Tafra L, "Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye" 233 : 51-59, 2001

10 Chen SL, "Lymphatic mapping and sentinel node analysis: current concepts and applications" 56 : 292-309, 2006

11 Feldman SM, "Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy" 188 : 248-254, 1999

12 Estourgie SH, "Excision biopsy of breast lesions changes the pattern of lymphatic drainage" 94 : 1088-1091, 2007

13 Cody HS 3rd, "Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures" 8 : 13-19, 2001

14 Varghese P, "Carpenter R. Methylene blue dye--a safe and effective alternative for sentinel lymph node localization" 14 : 61-67, 2008

15 Greenlee RT, "Cancer statistics, 2000" 50 : 7-33, 2000

16 Sakorafas GH, "Breast cancer surgery: historical evolution, current status and future perspectives" 40 : 5-18, 2001

17 Greco M, "Breast cancer patients treated without axillary surgery: clinical implications and biologic analysis" 232 : 1-7, 2000

18 Chagpar AB, "Biopsy type does not influence sentinel lymph node status" 190 : 551-556, 2005

19 Haigh PI, "Biopsy method and excision volume do not affect success rate of subsequent sentinel lymph node dissection in breast cancer" 7 : 21-27, 2000

20 Derossis AM, "A trend analysis of the relative value of blue dye and isotope localization in 2,000 consecutive cases of sentinel node biopsy for breast cancer" 193 : 473-478, 2001

21 Blessing WD, "A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping" 184 : 341-345, 2002