Staging the axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer.
OBJECTIVE
To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer.


METHODS
In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ((99m)Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located.


RESULTS
Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla.


CONCLUSIONS
The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue.
Ruano
R
R
Nuclear Medicine, University Hospital of Salamanca, Salamanca, Spain. ricardo.ruano@comsalamanca.es
Ramos
M
M
Garcia-Talavera
J R
JR
Serrano
E
E
De Arriba
A
A
Gonzalez-Orus
J
J
Iglesias
M
M
Macias
M C
MC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010173:Palpation; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012211:Rhenium; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C030406:technetium Tc rhenium-sulfur colloid; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium