The clinical value of parasternal sentinel node biopsy in breast cancer.
BACKGROUND
Lymphoscintigraphy (LS) with sentinel node (SN) biopsy is proposed to provide a feasible method to complete lymphatic staging in breast cancer. The aim of this study was to evaluate the clinical value of parasternal SN biopsy.


METHODS
A total of 984 consecutive patients with clinical stage T1/2N0 invasive breast cancer who underwent LS and SN biopsy were included in the study. A prospectively collected database was used. An intratumoral injection of 50 to 145 MBq of (99m)Tc-labeled human albumin colloid (Nanocoll) was used for preoperative LS.


RESULTS
LS showed the axillary SN in 844 (86%) cases and the parasternal SN in 138 (14%) cases. The median number of visualized parasternal SN was 2 (range, 1-6). Visualization of the parasternal SN was more common in patients with mediocentral tumors (81 of 399; 20%) and in patients with lateral tumors (56 of 585; 10%; P < .0001). Parasternal SNs were visualized more often, in 100 (17%) of 584 patients without axillary metastases compared with 38 (10%) of 400 patients with metastatic axillary nodes (P = .0006). Parasternal SNs were harvested successfully in 121 (88%) patients with visualization of those nodes. Parasternal SN metastases were detected in 18 patients, with a median of 1 metastasis (range, 1-4 metastases). Eight of these 18 patients were axillary node negative.


CONCLUSIONS
Parasternal SN biopsy results in upstaging in 2% of all breast cancer patients who undergo SN biopsy. The clinical value of the procedure seems insignificant, although it may influence the adjuvant treatment regimen in some patients.
Breast Surgery Unit, Helsinki University Hospital, FIN-00029 HUS, Helsinki, P.O. Box 140, Finland. marjut.leidenius@hus.fi
Marjut Hannele Kristiina
MH
Leidenius
Leena Anneli
LA
Krogerus
Terttu Sinikka
TS
Toivonen
Esa Antero
EA
Leppänen
Karl Albert Johan
KA
von Smitten
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D018714:Radiotherapy, Adjuvant; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid