La linfogammagrafía prequirúrgica y el grado histológico del tumor se asocian a la detección quirúrgica del ganglio centinela / Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node

Objetivo. Estudiar qué variables implicadas en el proceso de la biopsia selectiva del ganglio centinela (BSGC) influyen en la detección intraoperatoria del ganglio centinela. Material y métodos. Estudio transversal prospectivo de 210 pacientes (edad media: 54 años) diagnosticadas de cáncer de mama a las que se les realizó BSGC. Se recogieron los datos clínicos y radiológicos, de la administración del radioisótopo, quirúrgicos, de anatomía patológica y de seguimiento, y se realizó un análisis descriptivo y asociativo mediante una regresión múltiple multivariante. Resultados. La vía de inyección del radioisótopo más utilizada fue la profunda aislada (72,7%). La mayoría de las lesiones fueron palpables (57,1%), se presentaron como nódulos (67,1%), fueron menores de 2 cm (64,8%), se localizaron en el cuadrante supero-externo (49,1%), se trataba de carcinomas ductales (85,7%), con infiltración (66,2%) y el grado de diferenciación histológica fue ii (44,8%). Con la gammagrafía prequirúrgica se detectó el ganglio centinela en el 97,6% de los casos, y en el quirófano el 95,7%. Se observó una recurrencia axilar. En el estudio asociativo, las variables «linfogammagrafía prequirúrgica» y «grado de diferenciación histológica del tumor» mostraron una asociación estadísticamente significativa con la detección del ganglio centinela en el quirófano. Conclusión. La probabilidad de no detectar el ganglio centinela durante la intervención quirúrgica es mayor en los pacientes con tumores de alto grado histológico o en las que no se ha conseguido verlo en la linfogammagrafía prequirúrgica (AI)

Objective. To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. Material and methods. This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. Results. Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables «preoperative lymphoscintigraphy» and «histologic grade of differentiation of the tumor» were significantly associated with the detection of the sentinel lymph node during the operation. Conclusion. The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node (AU)

Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node.

OBJECTIVE: To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. MATERIAL AND METHODS: This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. RESULTS: Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables "preoperative lymphoscintigraphy" and "histologic grade of differentiation of the tumor" were significantly associated with the detection of the sentinel lymph node during the operation. CONCLUSION: The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node.

Estadificación ganglionar axilar prequirúrgica en el cáncer de mama: parámetros ecográficos y biopsia con aguja gruesa ecoguiada / Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound-guided core needle biopsy

Objetivo. Analizar el papel de la biopsia con aguja gruesa de adenopatías axilares con sospecha ecográfica de metástasis en pacientes con cáncer de mama, y la correlación radiopatológica. Material y métodos. Estudio retrospectivo de 74 pacientes diagnosticadas de cáncer de mama, a las que se realizó biopsia con aguja gruesa ecoguiada de adenopatías axilares con características ecográficas indicativas de metástasis. Consideramos hallazgos ecográficos sospechosos de metástasis: engrosamiento cortical, alteración de la grasa hiliar y/o flujo vascular cortical no hiliar. Las pacientes con biopsia axilar negativa se incluyeron en el protocolo de biopsia de ganglio centinela. Resultados. La biopsia con aguja gruesa confirmó metástasis ganglionar en 47 (63,5%) pacientes. Las 27 pacientes (36,5%) con biopsia negativa se incluyeron en el protocolo de biopsia de ganglio centinela y 3 (11%) presentaron ganglio centinela positivo, realizándose linfadenectomía axilar. De las 50 adenopatías con metástasis, 44 (88%) presentaron engrosamiento cortical, 20 (40%) alteración de la grasa hiliar y 29 (58%) flujo vascular cortical no hiliar. En todas las adenopatías con engrosamiento cortical y flujo vascular cortical no hiliar la biopsia fue positiva, indicando un valor predictivo positivo del 100% en esta serie. Conclusiones. La biopsia con aguja gruesa ecoguiada de adenopatías axilares con sospecha ecográfica de metástasis por cáncer de mama es un procedimiento con alta efectividad diagnóstica y baja morbilidad. La presencia de engrosamiento cortical y flujo vascular cortical no hiliar en la misma adenopatía mostró un valor predictivo positivo del 100% en esta serie (AU)

Objective. To analyze the role of core needle biopsy of axillary lymph nodes with suspected metastases from breast cancer and to correlate the imaging and histologic findings. Material and methods. We retrospectively studied 74 patients diagnosed with breast cancer who underwent ultrasound-guided core needle biopsy of axillary lymph nodes with characteristics suggestive of metastases on ultrasonography. The following ultrasonographic findings were considered suspicious for metastases: cortical thickening and changes in the hilar fat and/or non-hilar cortical vascular flow. Patients with negative findings after axillary biopsy underwent sentinel node biopsy. Results. Core needle biopsy confirmed lymph node metastases in 47 (63.5%) patients. The 27 patients (36.5%) with negative findings after lymph node biopsy underwent sentinel node biopsy; 3 (11%) of these had a positive sentinel lymph node and underwent axillary lymph node resection. Of the 50 lymph nodes with metastases, 44 (88%) had cortical thickening, 20 (40%) had changes in the hilar fat, and 29 (58%) had non-hilar cortical vascular flow. All biopsies of lymph nodes with both cortical thickening and non-hilar cortical vascular flow were positive, yielding a 100% positive predictive value in this series. Conclusions. Ultrasound-guided core needle biopsy of axillary lymph nodes that are suspicious for metastases from breast cancer at ultrasonography is a highly effective procedure that has low morbidity. Findings of cortical thickening and non-hilar cortical vascular flow in the same lymph node yield a positive predictive value of 100% in this series (AU)

[Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound-guided core needle biopsy]. / Estadificación ganglionar axilar prequirúrgica en el cáncer de mama: parámetros ecográficos y biopsia con aguja gruesa ecoguiada.

OBJECTIVE: To analyze the role of core needle biopsy of axillary lymph nodes with suspected metastases from breast cancer and to correlate the imaging and histologic findings. MATERIAL AND METHODS: We retrospectively studied 74 patients diagnosed with breast cancer who underwent ultrasound-guided core needle biopsy of axillary lymph nodes with characteristics suggestive of metastases on ultrasonography. The following ultrasonographic findings were considered suspicious for metastases: cortical thickening and changes in the hilar fat and/or non-hilar cortical vascular flow. Patients with negative findings after axillary biopsy underwent sentinel node biopsy. RESULTS: Core needle biopsy confirmed lymph node metastases in 47 (63.5%) patients. The 27 patients (36.5%) with negative findings after lymph node biopsy underwent sentinel node biopsy; 3 (11%) of these had a positive sentinel lymph node and underwent axillary lymph node resection. Of the 50 lymph nodes with metastases, 44 (88%) had cortical thickening, 20 (40%) had changes in the hilar fat, and 29 (58%) had non-hilar cortical vascular flow. All biopsies of lymph nodes with both cortical thickening and non-hilar cortical vascular flow were positive, yielding a 100% positive predictive value in this series. CONCLUSIONS: Ultrasound-guided core needle biopsy of axillary lymph nodes that are suspicious for metastases from breast cancer at ultrasonography is a highly effective procedure that has low morbidity. Findings of cortical thickening and non-hilar cortical vascular flow in the same lymph node yield a positive predictive value of 100% in this series.