Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer.
Identification of the sentinel node by using colloidal tracers and a gamma probe or lymphoscintigraphy could be an effective alternative for the complicated original dye-oriented approach. We studied the sentinel node detection rate using early and delayed imaging in breast cancer patients.


METHODS
Thirty-seven patients were imaged 2 hr and 18 hr after peritumoral injection of 99mTc-colloidal albumin. Preoperatively, axillary foci were located with a handheld gamma probe that was also used to isolate radiolabeled nodes from the axillary dissection specimens. The predictive value of the sentinel node for the axillary tumorstatus was evaluated with histological examination.


RESULTS
Two and 18 hr after injection, lymphoscintigraphy revealed one to three separate axillary lymph nodes in 33 and 34 patients, respectively. In 30 patients the axillary foci were easily localized with the gamma probe preoperatively. In all 34 patients (92%), with visualized axillary foci, at least one radioactive sample could be retrieved using the gamma probe (total 53 samples). Metastases were found in the sentinel nodes of 11 patients, in seven of 11 being the only tumor-positive lymph node in the axilla. There were no false-negative sentinel nodes.


CONCLUSIONS
The selective targeting and prolonged intranodal retention of 99mTc-colloidal albumin allows successful sentinel node identification in most (92%) patients.
Pijpers
R
R
Department of Nuclear Medicine, Academisch Ziekenhuis van de Vrije Universiteit, Amsterdam, The Netherlands.
Meijer
S
S
Hoekstra
O S
OS
Collet
G J
GJ
Comans
E F
EF
Boom
R P
RP
van Diest
P J
PJ
Teule
G J
GJ
D000368:Aged; D001365:Axilla; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin