Failure predictors of the sentinel lymph node in patients with breast cancer using Tc-99m sulfur colloid and periareolar injection.
OBJECTIVE
As sentinel lymph node (SLN) experience rises, it is important to identify factors that can limit lymphoscintigraphic mapping.


METHODS
A prospective study was conducted with breast cancer patients that were submitted to sentinel node mapping by lymphoscintigraphy between October 2003 and January 2005. The analyzed factors were: patients' age, body mass index, tumor size, previous breast surgeries, time between a previous biopsy and the radiotracer injection and their impact on preoperative SLN identification.


RESULTS
Two hundred and three breast cancer patients were injected with (99m)Technetium-sulfur colloid and submitted to lymphoscintigraphy scan for SLN biopsy. One hundred and eighty-four of these patients (90.64%) had a successfully identified SLN and 19 (9.36%) had a mapping failure. The median age of the successful group was 55.6 years and in the failure group was 57.1 years (P=0.002). The median body mass index was 25.3 and 27.6, respectively (P=0.024). The tumor size did not show any significant difference between the patients with successful mapping and failure (P=0.07). Previous breast surgery was an important limiting factor for SLN mapping (P=0.017). The mean time from biopsy to SLN detection was 23.6 days on the successfully marked patients and 17.4 days in the failure group (P<0.0001). All the 184 successfully mapped patients had the SLN identified. Only one patient of the failure group had the SLN identified using blue dye.


CONCLUSIONS
Advanced age, elevated body mass index, previous breast surgery and a shorter period of time after a breast biopsy are causes for SLN identification failure. The tumor size was not a limiting factor.
Pritsivelis
C
C
Department of Radiology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. cpritsivelis@globo.com
Garcia Mendonça
C A
CA
Pinheiro Pessoa
M C
MC
Coelho-Oliveira
A
A
Gutfilen
B
B
Barbosa Da Fonseca
L M
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid