title: Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation?
abstract: OBJECTIVE
  Identification of the sentinel lymph node (SLN) for small mammary tumours (cT1N0) sometimes leads to detection of internal mammary chain (IMC) drainage. This information is often ignored by physicians. The present study sought to determine the frequency with which an internal mammary SLN was identified by peritumoral injection of radioactive tracer, and then to determine the patients in whom identification of an internal mammary SLN could have an impact on the radiation treatment plan.
  
  
  METHODS
  Between March 2002 and March 2008, 622 SLN biopsies performed in a cohort of 608 patients were analysed. Technetium-labelled nanocolloids were administered via three peritumoral injections, completed by a deep prepectoral injection, with the entire procedure performed under echographic guidance.
  
  
  RESULTS
  The SLN was identified in 607 of the 622 patients, including 174 (28.7%) in the IMC. A total of 161 successful internal mammary biopsies were performed. Of the 622 patients, 18 showed SLN involvement in the IMC. In 7 of these patients, only the internal mammary SLN was affected. Prophylactic irradiation of the IMC was indicated in 376 patients, but only in 18 (4.8%) of these patients was there effectively IMC involvement; internal mammary SLN biopsy failed in 7 patients (1.9%).
  
  
  CONCLUSIONS
  SLN detection by peritumoral injection, combined with the systematic removal of the internal mammary SLN, enabled the involvement of this region to be found in a nonnegligible number of patients. Such information should make it possible to personalize treatment for patients with stage cT1 mammary cancer and thereby avoid needless internal mammary radiation therapy in a large number of patients (93.4% in our study).
authors.affiliation: Nuclear Medicine Department, Grenoble University Hospital, La Tronche, France. jcbourre@chu-grenoble.fr
authors.forename: Jean-Cyril
authors.initials: JC
authors.lastname: Bourre
authors.forename: Raoul
authors.initials: R
authors.lastname: Payan
authors.forename: Delphine
authors.initials: D
authors.lastname: Collomb
authors.forename: Céline
authors.initials: C
authors.lastname: Gallazzini-Crepin
authors.forename: Alex
authors.initials: A
authors.lastname: Calizzano
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Desruet
authors.forename: Dominique
authors.initials: D
authors.lastname: Pasquier
authors.forename: Michel
authors.initials: M
authors.lastname: Bolla
authors.forename: Daniel
authors.initials: D
authors.lastname: Fagret
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vuillez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D015331:Cohort Studies; D003102:Colloids / Q000737:chemistry; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D042361:Mammary Glands, Human / Q000473:pathology*; D008875:Middle Aged; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013667:Technetium / Q000494:pharmacology
chemical_list: D003102:Colloids; D019275:Radiopharmaceuticals; D013667:Technetium