Is there any benefit from sentinel lymph node biopsy using the combined radioisotope/dye technique in breast cancer patients with clinically negative axilla?
OBJECTIVE
We evaluated the eventual benefits from sentinel lymph node biopsy (SLNB) in comparison with axillary lymph node dissection (ALND) using a combined radioisotope/dye technique versus dye alone in breast cancer patients.


METHODS
SLNB was performed in 501 breast cancer patients (250 patients with dye alone and 251 with combined technique). Patients were divided in three groups: (A) clinical stage T1,2N0 (SLNB followed by ALND only in cases with positive histology), (B) clinical stage T1,2N0 (SLNB followed by ALND), and (C): advanced clinical stage (SLNB immediately followed by ALND). The incidence of recurrences and surgery morbidity was comparatively evaluated.


RESULTS
The overall successful identification rate in patients of groups A and B was 97.7% (95.3% with dye and 99.3% with dye and isotope, P = 0.04) and in patients of group C 96.1% (93.3% with dye and 1000% with the combined technique, P = 0.02). The false-negative rate did not reach statistical significance between groups. Although locoregional recurrence rate was similar in groups A and B (less than 1.88%) the distant metastasis rate was significantly lower in group A (0.9 vs. 6.6%, P = 0.04). Arm edema was significantly more frequent in group B (0 vs. 5.3%, P = 0.02).


CONCLUSIONS
The combined technique, improves the ID rate of SLNs in patients with breast cancer. The recurrence rate in the axilla was negligible and the metastasis-free rate was better in patients treated with SLNB alone, which further supports the concept that ALND has no clinical relevance and adds nothing more than morbidity to breast cancer patients with clinically node-negative disease.
Koukouraki
Sophia
S
Department of Nuclear Medicine, University Hospital, Heraklion 71110, Crete, Greece. sophiak@her.forthnet.gr
Sanidas
Elias
E
Askoxilakis
John
J
Stathaki
Maria
M
Charalambakis
Vassilis
V
Daboudi
Maria
M
Voutoufianaki
Ioanna
I
Kafousi
Maria
M
Stathopoulos
Eustathios
E
Tsiftsis
Dimitris
D
Karkavitsas
Nikolaos
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
D004396:Coloring Agents; D013668:Technetium Tc 99m Aggregated Albumin