Sentimag® Technique for Sentinel Lymph Node Biopsy in Breast Cancer Patients: Evaluation of Effectiveness, Feasibility and Challenges.

AIM: The gold standard technique of Sentinel Lymph Node Biopsy (SLNB) is the dual technique of radioactive tracer with blue dye. The aim of this study was to assess the node identification rate and feasibility in terms of ease of use of this technique for SLNB in breast cancer patients. Methods: Retrospectively collected data of 143 breast cancer patients with clinically and radiologically negative axilla were analysed. SLNB procedures were performed using the superparamagnetic iron oxide (SPIO) nanoparticles. Sentinel lymph nodes were identified using the Sentimag magnetometer and visual aid. Results: A total of 146 SLNB procedures were undertaken on 143 patients. Lymph node identification rate (IR) was 97.9%. Thirty seven patients (25.3%) were detected with cancer in their lymph nodes, 19% had at least one macrometastasis, 6% at least one micrometastasis and 1% had ITCs. The mean average lymph node retrieval was 2.2 nodes per procedure. Mild brownish discolouration was noted around the injection site. No allergic reaction or side effect of Sienna+î tracer / Magtraceî was reported. CONCLUSION: The new magnetic detection method of sentinel lymph nodes (Sentimag) is effective, feasible and comparable to the gold standard technique of sentinel lymph node biopsy in patients with breast cancer.

Should axillary ultrasound be used in patients with a preoperative diagnosis of ductal carcinoma in situ?

BACKGROUND: We evaluated the usefulness of axillary ultrasound (US) in patients with core biopsy-proven ductal carcinoma in situ (DCIS). METHODS: Preoperative axillary US, fine-needle aspiration (FNA), and sentinel lymph node (SLN) data from women with DCIS were reviewed. RESULTS: Eighty-two women with DCIS underwent axillary US. In 16 women (19.5%) US was abnormal; however, FNA was negative in all cases. Sixty-one women (74%) underwent SLN surgery; 2 were positive for macrometastasis (3%) and 1 had isolated tumor cells. None of them had an abnormal US. Axillary US did not change the management in any of the cases. CONCLUSIONS: Axillary US and FNA did not change the management in any of the 82 cases. In women with a core biopsy diagnosis of DCIS, positive nodes are uncommon and unlikely to be detected by axillary US. Routine preoperative axillary US is not recommended for pure DCIS on core biopsy.

Distance of breast cancer from the skin and nipple impacts axillary nodal metastases.

BACKGROUND: Lymphatic drainage of the breast is via subareolar and dermal lymphatics. The aim of this study was to determine whether distance of breast cancers from the skin and/or distance from the nipple impacts the likelihood of axillary nodal metastases. METHODS: A retrospective review was performed of sonographically visible T1 and T2 breast cancers with breast and axillary surgery performed at Mayo Clinic, Rochester, MN. Distance of tumor from the nipple was reviewed. Ultrasounds were reviewed to measure the distance of tumor from the skin. RESULTS: Data were collected on 233 eligible T1 or T2 breast cancers, of which 177 (76%) were node negative and 56 (24%) were node positive. On multivariable analysis, tumor stage and lymphovascular invasion, as well as decreasing distance of the tumor from the nipple and decreasing distance of the tumor from the skin, were significantly associated with axillary lymph node positivity. Each 1-cm decrease in the distance of the tumor from the nipple was associated with a 23% increased likelihood of positive lymph nodes (odds ratio 1.23; P = .003). Each 1-mm decrease in the distance of the tumor from the skin was associated with a 15% increased likelihood of positive lymph nodes (odds ratio 1.15; P = .003). CONCLUSION: T1 and T2 breast cancers located closer to the skin and those located closer to the nipple have a higher incidence of metastases to axillary lymph nodes. Distance from the skin and distance from the nipple should be considered when estimating a patient's likelihood of axillary nodal positivity.

Sentinel lymph node surgery in uncommon clinical circumstances.

Sentinel lymph node (SLN) surgery has largely replaced axillary dissection for nodal staging in clinically node negative breast cancer patients. However, in patients with previous breast and/or axillary surgery, pregnant patients, male patients, multifocal/multicentric breast tumors, DCIS, and patients receiving neoadjuvant chemotherapy, the use of SLN surgery is more controversial. Lymphoscintigraphy is important in patients with prior surgery to evaluate for drainage to extra-axillary sites.