Safety of sentinel node biopsy in breast cancer patients who receive a second radioisotope injection after visualization failure in lymphoscintigraphy.
OBJECTIVE
A failure to visualize axillary sentinel nodes in lymphoscintigraphy may lead to an unsuccessful sentinel node biopsy (SNB) and subsequent axillary lymph node dissection (ALND). To avoid unnecessary ALND, a second radioisotope injection may be given but has been considered hazardous. We investigated the axillary recurrence rate after tumor-negative SNB in breast cancer patients who received a second tracer injection after axillary visualization failure in lymphoscintigraphy.


METHODS
Altogether 1,309 breast cancer patients who underwent a tumor-negative SNB without an ALND were included. Two hundred seven (15.8%) patients received a second tracer injection due to visualization failure in lymphoscintigraphy and 1,102 (84.2%) did not. All patients received a blue dye injection prior to the SNB. The median follow-up time was 43 months.


RESULTS
No isolated cancer recurrences were diagnosed in the ipsilateral axilla among patients who received two radioisotope injections. Disease-free survival and overall survival were similar among patients with one or two radioisotope injections (P = 0.122 and P = 0.200, respectively).


CONCLUSIONS
Additional radiocolloid tracer injection after axillary non-visualization in lymphoscintigraphy is safe and does not increase axillary recurrence risk after tumor-negative SNB. The results suggest that such patients can be safely managed with SNB without a need to perform an ALND.
Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland. tuomo.meretoja@fimnet.fi
Tuomo J
TJ
Meretoja
Heikki
H
Joensuu
Päivi S
PS
Heikkilä
Marjut H
MH
Leidenius
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011300:Preoperative Care; D011868:Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects; D011877:Radionuclide Imaging; D019233:Retreatment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D017211:Treatment Failure
D011868:Radioisotopes