Single intralesional tracer dose for radio-guided excision of clinically occult breast cancer and sentinel node.
BACKGROUND
The purpose of this study was to determine the feasibility of both lymphatic mapping and probe-guided primary tumor excision by use of intralesional tracer administration in clinically occult breast cancer.


METHODS
Sixty patients with a clinically occult breast lesion were prospectively included. Lymphoscintigraphy was performed after intratumoral injection of 99mTc-labeled nanocolloid guided by ultrasound or stereotaxis. A catheter over a localization wire was inserted for intraoperative blue dye administration by using the same imaging techniques. After sentinel node identification, the gamma-ray detection probe was used for radio-guided wide local excision in patients who underwent breast-conserving therapy.


RESULTS
A sentinel node was visualized on the scintigrams in 56 patients (93%) and could be identified intraoperatively in 58 patients (97%). A sentinel node contained tumor in 10 (17%) of these patients. Extra-axillary sentinel nodes were visualized in 43%, were collected in 38%, and contained metastasis in 7% of the patients. Complete excision of the primary tumor could be accomplished in 39 (87%) of 45 patients.


CONCLUSIONS
Both sentinel node biopsy and probe-guided excision of a nonpalpable breast cancer is feasible with the aid of intralesional tracer administration. Sentinel node metastasis was found in 17% of the patients. A remarkably high percentage of extra-axillary drainage (43%) was observed.
Tanis
P J
PJ
Department of Surgery, The Netherlands Cancer Institute, Amsterdam. ptanis@nki.nl
Deurloo
E E
EE
Valdés Olmos
R A
RA
Rutgers
E J
EJ
Nieweg
O E
OE
Besnard
A P
AP
Kroon
B B
BB
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy; D008875:Middle Aged; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin