In search of the true sentinel node by different injection techniques in breast cancer patients.

AIMS: To evaluate two different injection techniques (peri-tumourally and intradermally) used in search for the sentinel node(s) in patients with breast cancer. METHODS: Ninety-nine patients were peri-tumourally injected with 2 ml 60 MBq 99m-Tc-Nanocoll and underwent lymphoscintigraphy about 18 h later to detect focal accumulations. Next, they were injected intradermally with 0.2 ml 15 MBq 99m-Tc-Nanocoll either in the skin overlying the tumour or para-areolarly in the quadrant of the tumour. Dynamic and static images were taken to visualize the (intradermal) lymphatic spread and accumulations. Special attention was paid to match or mismatch of hot spots visualized by both techniques. RESULTS: Ninety-four patients had positive peri-tumoural and/or intradermal accumulations which could be compared. In 30 patients only peri-tumoural, and in nine only intradermal, identification was successful. Of the remaining 55 patients, in 52 there was complete concordance of the axillary hot spots. However, there was a so-called <> in nine of these patients concerning the internal mammary nodes. In the three remaining patients there was a sequential mismatch in the axilla: before draining lymph to the peri-tumourally visualized hot spot, an interposed node was encountered first after the intradermal injection technique. CONCLUSIONS: Intradermal injection is complementary to peri-tumoural injection for visualization of focal accumulations in patients with breast cancer. The two different injection techniques have a small number of sequential mismatches for hot spots in the axillary region. This means that it may be unclear which separate route leads to the true sentinel node. Internal mammary nodes visualized after peri-tumoural injection are not visualized by the intradermal technique. Para-areolar intradermal injection of Nanocoll for detection of sentinel nodes in patients with breast cancer needs further evaluation, because it seems to be a more practical procedure.

Usefulness of the 14C urea breath test as a semi-quantitative monitoring instrument after therapy for Helicobacter pylori infection.

BACKGROUND: We evaluated the reliability and usefulness of the 14C urea breath test (UBT) in confirming eradication of Helicobacter pylori 4 to 6 weeks after cessation of antimicrobial therapy. METHODS: We investigated 57 patients, who underwent both an upper endoscopy with multiple biopsy specimens taken for histopathology, culture and/or CLO test, and a 14C UBT. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the breath test were calculated against the combined biopsy-based test results. Values for sensitivity, specificity, PPV, and NPV were also calculated after excluding results in a grey zone containing equivocal test results. RESULTS: Sensitivity, specificity, PPV, and NPV of the 14C UBT were 92%, 78%, 52%, and 97%, respectively. After introduction of a grey zone concept, these values were 89%, 100%, 100%, and 97% respectively. CONCLUSIONS: We conclude that for research, upper gastrointestinal endoscopy with multiple biopsy specimens and using different diagnostic techniques should remain the 'gold standard' to test for cure.

Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer.

Sentinel node (SN) biopsy technique has been reported to be a very accurate staging procedure in patients with stage I/II melanoma. Whether it is as accurate in patients with breast cancer has to be studied more extensively. Eighty-three patients with clinically T1-T2 N0M0 breast cancer were peri-tumorally injected with 99m-Tc colloidal-albumin. Lymphoscintigraphy was performed either 4 or 18 h after the injection. Using a gamma probe the SN were located in vivo, removed from the axillary specimen and sent for histological examination. No focal accumulation was seen on the lymphoscintigraphy in 17 patients. Two patients had parasternal SN locations only and in seven patients the localization of the SN failed. Of the remaining 57 patients, 23 had positive axillary basins, of which 22 were correctly predicted by one or more positive SN. There was one false-negative biopsy (sensitivity=96%). In 12 of the 22 positive axillary basins, SN was the only positive node. We conclude that the SN biopsy technique is a promising and feasible procedure in about three-quarters of patients with clinically T1-T2 N0M0 breast cancer. However, more data are needed to establish the actual sensitivity of this procedure.