[Micrometastasis in the sentinel node and axillary lymph node macro-metastasis in breast cancer].
OBJECTIVE
The study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes.


METHODS
159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement.


RESULTS
A total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macro-metastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified.


CONCLUSIONS
It is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies.
Cordero García
J M
JM
Servicio de Medicina Nuclear, Hospital General de Ciudad Real, Ciudad Real, España. jmcordero@sescam.jccm.es
Delgado Portela
M
M
García Vicente
A M
AM
Pilkington Woll
J P
JP
Palomar Muñoz
M A
MA
Poblete García
V M
VM
Bellón Guardia
M E
ME
Pardo García
R
R
Rabadán Ruiz
L
L
Soriano Castrejón
A M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000556:secondary*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015642:Radiology, Interventional; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012306:Risk; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013194:Staining and Labeling; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D019564:Unnecessary Procedures
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid