title: Usefulness of combined sestamibi scintimammography, axillary ultrasonography and FNA cytology in reducing the number of sentinel node procedures in patients with early-stage breast cancer.
abstract: BACKGROUND
  Intraoperative analysis of the sentinel lymph node (SLN) status is currently performed in patients with breast cancer (BC) undergoing surgery. Axillary node (AN) metastases are present in up to 60% of cases, but the risk is only 30% in patients with early stage (T1) BC. The aim of this study was to evaluate the usefulness of 99mTc-sestamibi scintimammography (SSM), axillary ultrasonography (US) and US-guided fine-needle aspiration (FNA) cytology together in detecting axillary metastases preoperatively and their potential role in reducing the number of SLN procedures.
  
  
  METHODS
  A series of 86 consecutive women (median age 57 years, range 30-72) with confirmed BC and clinically negative nodes (T1N0) underwent both SSM and US prior to surgery. US-guided FNA cytology was performed in all the patients with suspicious AN on US, or positive SSM and ultrasonographically visualized enlarged nodes.
  
  
  RESULTS
  Final pathology showed 4 pT1bN0, 1 pT1bN1, 60 pT1cN0 and 21 pT1cN1 BC. The sensitivity, specificity, and accuracy were 59.1%, 93.7% and 84.9% for SSM, 63.6%, 90.6% and 83.7% for US, and 72.7%, 97.8% and 90.7% for SSM and US together. Using FNA cytology the specificity reached 100%, but the sensitivity did not increase. A combined method using radioisotope and blue dye was used for SLN biopsy. The procedure was omitted in patients with FNA cytology showing AN metastases (N = 14, 16.3%) and they underwent level I-II axillary dissection, as well as those with positive SLN biopsy on frozen section (8 out of 72, 11.1%).
  
  
  CONCLUSIONS
  In patients with BC, preoperatively selected by SSM and US in whom US-guided axillary FNA cytology has shown the presence of AN metastases, the SLN biopsy can be avoided and AN dissection should be the primary procedure.
authors.affiliation: University of Padua, School of Medicine, Breast Surgery Unit, Department of Surgical and Gastroenterological Sciences, via Giustiniani 2, 35128 Padova, Italy. flumachi@unipd.it
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Borsato
authors.forename: Alberto
authors.initials: A
authors.lastname: Tregnaghi
authors.forename: Guido
authors.initials: G
authors.lastname: Ferretti
authors.forename: Michele
authors.initials: M
authors.lastname: Povolato
authors.forename: Diego
authors.initials: D
authors.lastname: Cecchin
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marzola
authors.forename: Pietro
authors.initials: P
authors.lastname: Zucchetta
authors.forename: Franco
authors.initials: F
authors.lastname: Bui
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Fassina