ABSTRACT
Intratumoral injection of a radiocolloid for lymphatic mapping enables the therapeutic excision of clinically occult breast cancer with the aid of a gamma-ray detection probe. The aim of this study was to determine the success rate of radio-guided tumour excision in addition to a guide wire and to identify factors predicting clear margins. Sixty-five consecutive patients underwent radio-guided tumour excision after intratumoral injection of 99mTc-nanocolloid guided by ultrasound or stereotaxis. A localization wire was inserted after scintigraphy had been performed (group 1). The results were compared with retrospective data from 67 consecutive patients who underwent therapeutic wire-directed excision alone (group 2). Factors predicting clear margins (> or = 1 mm) were determined in a logistic regression model. Adequate margins were obtained in 83% of group 1 and in 64% of group 2 (P = 0.014). The invasive component was incompletely excised in two patients in group 1 and in 14 patients in group 2. Further surgery was performed in four patients in group 1 and in 14 patients in group 2. Factors predictive of clear margins were decreasing pathological tumour diameter (P = 0.035), increasing weight of the specimen (P = 0.046), absence of microcalcifications (P = 0.004) and absence of carcinoma in situ component (P = 0.024). Radio-guided excision was an independent predictor of complete excision of the invasive component (P = 0.012). The application of radio-guided surgery combined with wire localization seems to improve the outcome of therapeutic excision of non-palpable invasive breast cancer compared with wire-directed excision alone.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Surgery, Computer-Assisted/methods , Technetium Tc 99m Aggregated Albumin , Catheterization/methods , Female , Humans , Middle Aged , Palpation , Radionuclide Imaging , Radiopharmaceuticals , Severity of Illness Index , Treatment OutcomeABSTRACT
Regional lymphadenectomy in patients with cutaneous malignant melanoma in stages I-U AJC/UICC has not demonstrated improvement either in loco-regional control or in survival. The results of the lymphatic mapping technique have demonstrated that on identifying the sentinel node, the group of patients with microscopic nodal metastases can be selected for regional treatment. We performed the intraoperative lymphatic mapping technique with 1 ml of blue patent V by intradermal injection just around the primary melanoma; after injecting the dye we incised the nodal skin region, identifying the sentinel node by its blue color. The histologic examination, by frozen section of this node, determines whether or not to proceed with a formal lymphadenectomy. We calculated the sensitivity of the dye for the identification of the sentinel node and the Pearson's test was performed between the intraoperative histologic study and the definite pathological result. Thirty one lymphatic mappings were performed in 29 patients with stages I-II malignant cutaneous melanoma. The sentinel node was found in 26/31 explored lymphatic zones, and in 5, it was not found, sensitivity of 84%; 23/26 sentinel nodes were negative and only 3/26 were metastatic in frozen section. The Pearson's test result was 0.78 with a predictive value of 92%. The blue patent V intraoperative lymphatic mapping technique in patients with malignant cutaneous melanoma provided a great sensitivity to identify the sentinel node and allows the identification of patients with high risk of microscopic nodal metastases.
