ABSTRACT
OBJECTIVE: The objective of this study is to analyze the influence of tumor size and age of the patient in the detection of the SN in breast neoplasms. MATERIAL AND METHODS: A total of 190 patients affected of breast cancer with a mean age of 57 years (range from 28 to 87 years) were studied. According to age, the following were distinguished: under 40 years, 23 patients; between 40 and 60 years, 102 patients and over 60 years, 65 patients. The lesions were classified based on size (in mm) into: less than 10 in 27 patients, between 10 and 20 in 61 patients, between 20 and 30 in 64 patients, and greater than 30 in 38 patients. In all the cases, a scintigraphy was performed at 2 hr. post-injection of 3 mCi of 99mTc-nanocoloide, in the peritumoral area. After lymphoscintigraphy detection of the SN, cutaneous labeling was performed and it was detected surgically by a gamma detector probe. A complete lymphadenectomy was performed in all the patients. The histopathology was performed with hematoxylin-eosin and immunohistochemistry techniques and the state of the SN was compared with the remaining lymph nodes of the lymphadenectomy. RESULTS: The SN was located in 169 of the 190 cases (89%). In 164 cases, it was found in the axilla. The greatest percentage of those not detected was observed in tumors over 30 mm (32%) and patients older than 60 years (30%). No false negative were observed in tumors under 10 mm or in patients under 40 years, but the false negative rate increased with the patient's age and the tumor size. CONCLUSIONS: The patient's age and tumor size seem to influence SN detection rates. The FN rates seem to be superior in patients over 60 years. Patients under 40 years with tumors less than 10 mm are those who benefit most from this technique.
Subject(s)
Breast Neoplasms/pathology , Sentinel Lymph Node Biopsy , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Middle AgedABSTRACT
Objetivo: El objetivo de este estudio es analizar la influencia del tamaño del tumor y la edad de la paciente en la detección del GC en neoplasias de mama. Material y métodos: Se estudiaron 190 pacientes afectas de neoplasia de mama. Edad media de 57 años (rango comprendido entre 28 y 87 años). Según la edad distinguieron: menores de 40 años, 23 pacientes; entre 40 y 60 años, 102 pacientes y mayores de 60 años, 65 pacientes. Las lesiones se clasificaron en función del tamaño (en mm) en: menor de 10 en 27 pacientes, entre 10 y 20 en 61 pacientes, entre 20 y 30 en 64 pacientes, y superior a 30 en 38 pacientes. En todos los casos se practicó una gammagrafía a las 2 h post-inyección de 3 mCi de 99mTc-nanocoloide, en el área peritumoral. Tras la detección linfogammagráfica del GC se realizó un marcaje cutáneo, y mediante una sonda gammadetectora se detectó quirúrgicamente. En todas las pacientes se realizó linfadenectomia completa. La histopatología se realizó con técnicas de hematoxilina-eosina e inmunohistoquimia, y se comparó el estado del GC con el resto de ganglios de la linfadenectomía. Resultados: El GC se localizó en 169 de los 190 casos (89 por ciento). En 164 casos se localizó en axila. El mayor porcentaje de no detecciones se observó en tumores mayores de 30 mm (32 por ciento) y pacientes mayores de 60 años (30 por ciento). No se observaron falsos negativos en tumores de menos de 10 mm ni en pacientes menores de 40 años, pero la tasa de falsos negativos aumenta con la edad de la paciente y el tamaño del tumor. Conclusiones: La edad de las pacientes y el tamaño del tumor parece influir en las tasas de detección del GC. Las tasas de FN parecen ser superiores en las pacientes mayores a 60 años. Las pacientes menores de 40 años y con tumores de menos de 10 mm son las que más se benefician de esta técnica (AU)
Subject(s)
Middle Aged , Adult , Aged, 80 and over , Aged , Female , Humans , Sentinel Lymph Node Biopsy , Age Factors , Breast NeoplasmsABSTRACT
The aim of this study was to demonstrate that radionuclide sentinel node detection can be applied to patients with non-palpable breast cancer. One hundred and ten consecutive women with unilateral breast cancer were studied. Group 1 was made up of 80 patients with palpable breast cancer (mean age, 58 years) and group 2 of 30 patients with non-palpable breast cancer detected mammographically (mean age, 55 years). Tc-nanocolloid (111 MBq) was injected peritumorally in palpable tumours, and in the tumour area (ultrasound guided) in non-palpable tumours. At 2 h post-injection, anterior and lateral scintigrams were obtained from patients in the supine position. The location of the sentinel node was marked on the patient's skin. Patients with non-palpable tumours were moved to the surgery room 3 h later, and those with palpable tumours 24 h later. The histopathological study included three haematoxylineosin sections and immunochemistry. All patients underwent axillary lymphadenectomy. The sentinel node was detected in 67 cases (84%) in group 1 and in 28 cases (93%) in group 2. In four patients (5%) in group 1 and two patients (7%) in group 2, no axillary sentinel node was detected in the surgical bed, although it had been seen in scintigraphy. In nine patients (11%) in group 1, neither scintigraphic nor surgical detection was successful. Skip metastasis was seen in six cases (10%) of palpable tumours and in one case (4%) of non-palpable tumours. It can be concluded that non-palpable breast tumours cannot be considered an exclusion criterion for sentinel node localization and biopsy. Ultrasonography-guided injection, followed by scintigraphic and surgical detection of the sentinel node, may help in the management of patients with non-palpable breast tumours.
Subject(s)
Breast Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Aggregated Albumin , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Gamma Cameras , Humans , Lymph Node Excision , Lymph Nodes/pathology , Lymph Nodes/surgery , Middle Aged , Radionuclide Imaging , Sentinel Lymph Node BiopsyABSTRACT
The aim of this study was to analyse the accuracy of scintigraphic and gamma probe sentinel node (SN) localization in breast cancer patients who have been submitted to neoadjuvant chemotherapy (NC). Seventy-six patients with single breast cancer were included in the study, and were classified into two groups. Group 1 consisted of 40 women who had received NC, and Group 2 consisted of 36 women who did not receive NC. All patients received 111 MBq (3 mCi) of 99Tcm-nanocolloid in 3 ml, by peritumoural injection. Anterior and lateral thoracic scans were obtained 2 h post-injection. The following day (18-24 h post-injection) the patients underwent surgery and sentinel nodes were localized by using a gamma probe. Complete axillary lymph node dissection was performed in all patients. Histological analysis included haematoxylin-eosin in all cases and immunohistochemistry in 10 cases. In Group 1, SNs were localized in 36/40 patients, histological analysis was performed in 34 and there were four false negatives (22%). In Group 2, SNs were localized in 32/36 patients, histological analysis was performed in 29 and there were two false negatives (9%). Predictive negative values were 78% and 90% in Groups 1 and 2, respectively. In summary, sentinel node localization in breast cancer patients submitted to previous neoadjuvant chemotherapy is less accurate than in patients who do not receive this therapy. The procedure is not sufficiently accurate to localize the sentinel node, thus it cannot be recommended in these patients.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/drug therapy , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Female , Humans , Lymph Node Excision , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and Specificity , Sentinel Lymph Node Biopsy , Technetium Tc 99m Aggregated AlbuminABSTRACT
The aim of this preliminary work is to show the results of the radioisotopic localization of the sentinel node in breast cancer and the surgical resection using a gamma probe. We studied 10 patients with breast cancer without primary chemotherapy and 3 patients with primary chemotherapy before surgery. A lymphoscintigraphy was made after injection of 111 MBq of Tc99m-nanocolloid in a volume of 3 ml. The scans were performed after 30 minutes, 2 hours, 4 hours and 24 hours after injection. We detected the node and then a skin mark was made. The next day, surgical resection of this node was performed, guided by a gamma probe. We detected all sentinel nodes but one: 12 sentinel nodes and 7 second echelon nodes. The mean time for a surgical detection was about 16 minutes. In our experience this technique allows an accurate localization of the sentinel node in patients with breast cancer. We are able to localize the node in the surgical room guided with gamma probe. The peroperatory evaluation by anatomopathological techniques shown the status of this node. All this, does not delay the surgical time.
Subject(s)
Breast Neoplasms/diagnostic imaging , Cobalt Radioisotopes , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Technetium , Adult , Antineoplastic Agents/therapeutic use , Breast Neoplasms/pathology , Colloids , Female , Frozen Sections , Humans , Lymph Node Excision/methods , Middle Aged , Neoplasm Staging , Radionuclide ImagingABSTRACT
The authors carried out 88 sutures of the ascending colon in Wistar rats, 44 in inversion and the remainder in eversion. The suture material used was monofilament 9/0 nylon. The intestinal diameter was measured using an instrument and the healing process studied by means of the following parameters: granulocytes, oedema, fibrin, fibroblasts and re-epithelialisation of the mucosa, on histology. The results prove that inverted sutures heal within 10 days, whereas everted sutures are not healed after 17 days. Furthermore, we demonstrated the fact that, after 72 hours, the intestinal caliber above the suture showed no appreciable differences compared with that of the normal colon.
