title: Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer.
abstract: Lymphoscintigraphy associated with radioguided biopsy of the sentinel node (SN) is well established in clinical practice for melanoma. In breast cancer, the SN concept is similarly valid, and lymphoscintigraphy is a useful method for localizing the axillary SN. The aim of this study was to optimize the lymphoscintigraphy technique in association with a gamma ray detecting probe (GDP) for identifying and removing the SN in breast cancer patients.
  
  
  METHODS
  Two-hundred fifty patients with operable breast tumor underwent lymphoscintigraphy before surgery. Three different size ranges of 99mTc-labeled colloid particles (<50, <80 and 200-1000 nm) were used, with either subdermal (above tumor) or peritumoral injection. Early and late scintigraphic images were obtained in anterior and oblique projections, and the skin projection of the detected SN was marked. Sentinel nodes were identified and removed with the aid of the GDP during breast surgery; they were tagged separately. Complete axillary dissection followed. In 40 patients, a blue dye was also administered in addition to subdermal radiolabeled colloid to compare blue dye mapping with lymphoscintigraphy localization.
  
  
  RESULTS
  Lymphoscintigraphy successfully revealed lymphatic drainage in 245 of 250 patients (98%). The axillary SN was identified in 240 patients (96%). SN biopsy correctly predicted axillary node status in 234 of 240 patients (97.5%). Lymphoscintigraphy and GDP detected the SN most easily and consistently when 200-1000 nm colloid was administered subdermally in an injection volume of 0.4 ml. Blue dye mapping was successful in 30 of 40 patients (75%). In 26 of these patients, the dye and lymphoscintigraphy identified the same node; in 4 cases different nodes were identified. None of these four patients had axillary disease.
  
  
  CONCLUSIONS
  Lymphoscintigraphy is a simple procedure that is well tolerated by patients. Sentinel node identification is more reliable when large-size radiolabeled colloids are injected in a relatively small injection volume (0.4 ml). Use of a GDP greatly facilitates precise pinpointing and rapid removal of the SN.
authors.affiliation: Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: De Cicco
authors.forename: M
authors.initials: M
authors.lastname: Cremonesi
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: M
authors.initials: M
authors.lastname: Bartolomei
authors.forename: C
authors.initials: C
authors.lastname: Grana
authors.forename: G
authors.initials: G
authors.lastname: Prisco
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: P
authors.initials: P
authors.lastname: Calza
authors.forename: G
authors.initials: G
authors.lastname: Viale
authors.forename: U
authors.initials: U
authors.lastname: Veronesi
authors.forename: G
authors.initials: G
authors.lastname: Paganelli
mesh_terms: D000965:Antimony; D001365:Axilla; D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D003102:Colloids; D005260:Female; D005720:Gamma Rays; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D003102:Colloids; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D013668:Technetium Tc 99m Aggregated Albumin; C019096:technetium Tc 99m antimony sulfide; D000965:Antimony