Reproducibilidad de la linfogammagrafía antes y después de la biopsia excisional de las lesiones primarias de mama: estudio utilizando la inyección periareolar superficial del radiotrazador / Reproducibility of lymphoscintigraphy before and after excisional biopsy of primary breast lesions: A study using superficial peri-areolar injection of the radiotracer

Objetivo. Una cuestión de gran controversia en la biopsia del ganglio centinela de la mama es la aplicabilidad del estudio del ganglio centinela en pacientes con historia previa de biopsia excisional de las lesiones de la mama. En el presente estudio, evaluamos la reproducibilidad de la linfogammagrafía antes y después de la biopsia excisional de las lesiones primarias de mama utilizando la inyección periareolar superficial del radiotrazador. Material y métodos. Se incluyó en el estudio a 18 pacientes programadas para biopsia excisional de lesiones de mama. A las pacientes se les administró una inyección intradérmica del radiotrazador en el área periareolar del cuadrante con tumor, con 1 o 2h antes de la cirugía. La imagen se obtuvo el día posterior a la operación. Inmediatamente tras la primera imagen, a las pacientes se les administró otra inyección del radiotrazador con la misma técnica, dosis y localización. Se realizaron inmediatamente otras series de imágenes de linfogammagrafía, y a las 4h después de la segunda inyección. Se compararon las 2 series de imágenes de linfogammagrafía. Resultados. En 2 pacientes no se pudo identificar el ganglio centinela en ninguna de las series de imágenes. En las 16 pacientes restantes se detectó un ganglio centinela en ambas series de imágenes de linfogammagrafía. Los ganglios centinela de las segundas series de imágenes se detectaron en la misma localización que las primeras series de imágenes, con un contaje al menos 5 veces superior. Conclusiones. La biopsia excisional de las lesiones primarias de mama no parece modificar el patrón del drenaje linfático superficial desde la areola de la mama, pudiendo realizarse el estudio del ganglio centinela tras esta intervención, utilizando la técnica periareolar superficial(AU)

Objective. A major controversial issue in the sentinel node biopsy of the breast is the applicability of sentinel node mapping in patients with the history of previous excisional biopsy of the breast lesions. In the current study, we evaluated the reproducibility of lymphoscintigraphy before and after excisional biopsy of the primary breast lesions using superficial peri-areolar injection of the radiotracer. Material and methods. Eighteen patients scheduled for excisional biopsy of breast lesions were included into the study. The patients received intra-dermal injection of the radiotracer in the peri-areolar area of the index quadrant 1 to 2h before surgery. Imaging was performed the day after surgery. Immediately after completion of the first imaging, the patients received another injection of the radiotracer with the same technique, dose, and location. Other sets of lymphoscintigraphy imaging were taken immediately and 4h post second injection. The two sets of lymphoscintigraphy images were compared. Results. In 2 patients, sentinel node could not be identified in either set of images. In the remaining 16 patients, one sentinel node was detected in both lymphoscintigraphy image sets. The sentinel nodes of the second image sets were all in the same location of the first sets with at least 5 times higher count. Conclusions. Excisional biopsy of the primary breast lesions does not seem to change the superficial lymphatic drainage pattern from the areola of the breast and sentinel node mapping can be performed after this procedure using superficial periareolar technique(AU)

Reproducibility of lymphoscintigraphy before and after excisional biopsy of primary breast lesions: a study using superficial peri-areolar injection of the radiotracer.

OBJECTIVE: A major controversial issue in the sentinel node biopsy of the breast is the applicability of sentinel node mapping in patients with the history of previous excisional biopsy of the breast lesions. In the current study, we evaluated the reproducibility of lymphoscintigraphy before and after excisional biopsy of the primary breast lesions using superficial peri-areolar injection of the radiotracer. MATERIAL AND METHODS: Eighteen patients scheduled for excisional biopsy of breast lesions were included into the study. The patients received intra-dermal injection of the radiotracer in the peri-areolar area of the index quadrant 1 to 2h before surgery. Imaging was performed the day after surgery. Immediately after completion of the first imaging, the patients received another injection of the radiotracer with the same technique, dose, and location. Other sets of lymphoscintigraphy imaging were taken immediately and 4h post second injection. The two sets of lymphoscintigraphy images were compared. RESULTS: In 2 patients, sentinel node could not be identified in either set of images. In the remaining 16 patients, one sentinel node was detected in both lymphoscintigraphy image sets. The sentinel nodes of the second image sets were all in the same location of the first sets with at least 5 times higher count. CONCLUSIONS: Excisional biopsy of the primary breast lesions does not seem to change the superficial lymphatic drainage pattern from the areola of the breast and sentinel node mapping can be performed after this procedure using superficial periareolar technique.

Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer

ObjetivoLa biopsia selectiva del ganglio centinela es el método estándar para la estadificación axilar del cáncer de mama. En algunas pacientes el ganglio centinela no es identificado durante la cirugía y tiene que realizarse una linfadenectomía axilar estándar. En este estudio hemos evaluado los factores predictores del fallo en la localización del ganglio centinela utilizando la administración intradérmica del radiotrazador combinada con la inyección de colorante azul de metileno.Material y métodosSe evaluaron retrospectivamente 202 pacientes consecutivas con cáncer de mama, clínicamente estadios I o II. Se analizan y comparan diferentes variables entre las pacientes cuyo ganglio centinela se localizó durante la cirugía y aquellas que no fue posible la detección del ganglio centinela.ResultadosEl ganglio centinela fue identificado en la linfogammagrafía previa en 180 pacientes (89%). El análisis uni y multivariable mostró que la no visualización del ganglio centinela en la linfogammagrafía, la experiencia del cirujano y la existencia de metástasis en los ganglios axilares se asocian con fallo de localización del ganglio centinela durante la cirugíaConclusionesEste estudio muestra la importancia de la linfogammagrafía previa a la cirugía para predecir aquellos pacientes con posible fallo en la localización quirúrgica del ganglio centinela. Recomendamos la necesidad de una fase de aprendizaje de la técnica antes de su aplicación clínica rutinaria(AU)

ObjectiveThe standard method for axillary lymph node staging in early breast cancer is sentinel lymph node biopsy. In some patients the sentinel lymph node can not be localized during surgery and these patients have to undergo standard axillary lymph node dissection. In this study we have evaluated the predictors of sentinel lymph node localization failure using 99mTc-antimony sulfide colloid and intradermal injection combined with blue dye technique.Material and methods202 consecutive patients with early stage breast cancer (clinically stage I or II) were retrospectively evaluated. Patients whose sentinel lymph node was localized during surgery were compared to those with localization failure considering several variables.ResultsSentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 180 patients (89%). Both univariate and multivariate analyses showed that only sentinel lymph node non-visualization by pre-operative lymphoscintigraphy, experience of the surgeon, and axillary lymph node involvement are associated with sentinel node localization failure during surgery.ConclusionsThis study shows the importance of pre-operative lymphoscintigraphy in order to identify the group of patients with possible localization failure during surgery and warning the surgeon beforehand. We also recommend that all surgeons pass the learning curve of sentinel lymph node biopsy before routinely performing this procedure(AU)

Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer.

OBJECTIVE: The standard method for axillary lymph node staging in early breast cancer is sentinel lymph node biopsy. In some patients the sentinel lymph node can not be localized during surgery and these patients have to undergo standard axillary lymph node dissection. In this study we have evaluated the predictors of sentinel lymph node localization failure using (99m)Tc-antimony sulfide colloid and intradermal injection combined with blue dye technique. MATERIAL AND METHODS: 202 consecutive patients with early stage breast cancer (clinically stage I or II) were retrospectively evaluated. Patients whose sentinel lymph node was localized during surgery were compared to those with localization failure considering several variables. RESULTS: Sentinel lymph node was successfully located on the pre-operative lymphoscintigraphy images in 180 patients (89%). Both univariate and multivariate analyses showed that only sentinel lymph node non-visualization by pre-operative lymphoscintigraphy, experience of the surgeon, and axillary lymph node involvement are associated with sentinel node localization failure during surgery. CONCLUSIONS: This study shows the importance of pre-operative lymphoscintigraphy in order to identify the group of patients with possible localization failure during surgery and warning the surgeon beforehand. We also recommend that all surgeons pass the learning curve of sentinel lymph node biopsy before routinely performing this procedure.