[Optimization of sentinel lymph node biopsy in breast cancer by intraoperative axillary palpation].
BACKGROUND
Sentinel node biopsy (SNB) by radioisotopes is a widely accepted and reliable surgical method for staging breast cancer in patients with unknown positive axillary lymph nodes involvement. The main limitation of this method is due to the appearance of false negatives that may be caused by tumor lymph node blockage of the sentinel lymph node and uptake in the neighboring lymph nodes. Infiltered sentinel nodes are generally increased in size and firm. Thus, they can be detected by intraoperative palpation, even when there is no uptake by the radiotracer.


OBJECTIVE
To reduce the false negative rates by applying intraoperative axillary palpation after SNB.


METHODS
Over a two-year period, we complemented the SNB in 168 patients with careful intraoperative axillary palpation, detecting and removing all the palpable suspicious lymph nodes (SLN) that were analyzed as sentinel nodes


RESULTS
In 32 out of 168 patients, 50 palpable SLN were found. In 3 out of 32 patients, 4 infiltrated SLNs were demonstrated with negative SNB and positive axillary lymphadenectomy. Thus, intraoperative palpation avoided false negative results. In one patient, one palpable SLN with tumor involvement was observed and SNB was also positive. In the remaining 28 patients, the histological analysis of 45 SLN was negative for tumor but SNB was positive in 3 patients.


CONCLUSIONS
Intraoperative axillary palpation, once the SNB was done, reduced the false negative rate. Thus, we consider that it should be included as one more part of this procedure.
Serrano Vicente
J
J
Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España. titoserrano@gmail.com
Infante de la Torre
J R
JR
Domínguez Grande
M L
ML
García Bernardo
L
L
Durán Barquero
C
C
Rayo Madrid
J I
JI
Sánchez Sánchez
R
R
Correa Antúnez
M I
MI
Amaya Lozano
J L
JL
Conde Martín
A F
AF
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008408:Mastectomy; D010173:Palpation / Q000379:methods*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
D019275:Radiopharmaceuticals