title: Prospective comparison of 3 gamma-probes for sentinel lymph node detection in 200 breast cancer patients.
abstract: Previous reports have shown that axillary sentinel lymph node (ASLN) radiodetection allows accurate axillary staging for patients with early breast cancer. Radioguided surgery implies the use of a gamma-probe to count the emitted radioactivity of marked ASLNs. Several gamma-probes are commercially available, each with its own properties. The clinical impact of the type of gamma-probe used for ASLN radiodetection remains to be evaluated.
  
  
  METHODS
  Three commercially available gamma-probes were evaluated: a scintillator with a bismuth germanate crystal (probe A), a semiconductor with a cadmium telluride crystal (probe B), and a semiconductor with a cadmium zinc telluride crystal (probe C). Two hundred patients with early breast cancer were prospectively enrolled to undergo ASLN radiodetection and axillary lymphadenectomy. ASLN mapping consisted of injecting (99m)Tc-sulfur-colloid around the tumor. For each patient, sentinel lymph nodes were counted successively with the 3 probes and the sensitivity of each gamma-probe was determined from ASLN residual activity. The results of detection rates and false-negative rates for each probe were compared.
  
  
  RESULTS
  Mean residual ASLN activity was 52 kBq (range, 0.07-189 kBq). Sensitivity was compared among the 3 probes and found to be best for probe A. The detection rate of probe A was significantly better than that of probe B (93% vs. 86%, P = 0.05) but not different from that of probe C (93% vs. 90%). No differences in false-negative rates were observed among the 3 probes.
  
  
  CONCLUSIONS
  ASLN detection rate depends on the type of gamma-probe used. Because failure to detect the ASLN leads to complete axillary lymphadenectomy, involving local morbidity and other sequelae, the type of gamma-probe must be considered important for sentinel lymph node radiodetection.
authors.affiliation: Department of Oncological Surgery, René Gauducheau Cancer Center, Saint-Herblain, France. jm-classe@nantes.fnclcc.fr
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Classe
authors.forename: Maryse
authors.initials: M
authors.lastname: Fiche
authors.forename: Caroline
authors.initials: C
authors.lastname: Rousseau
authors.forename: Christine
authors.initials: C
authors.lastname: Sagan
authors.forename: François
authors.initials: F
authors.lastname: Dravet
authors.forename: Raphaëlle
authors.initials: R
authors.lastname: Pioud
authors.forename: Albert
authors.initials: A
authors.lastname: Lisbona
authors.forename: Ludovic
authors.initials: L
authors.lastname: Ferrer
authors.forename: Loic
authors.initials: L
authors.lastname: Campion
authors.forename: Isabelle
authors.initials: I
authors.lastname: Resche
authors.forename: Chantal
authors.initials: C
authors.lastname: Curtet
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013673:Technology Assessment, Biomedical