title: The sentinel node procedure in breast cancer: nuclear medicine as the starting point.
abstract: Axillary node status is a major prognostic factor in early breast cancer. Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (<5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting patients for whom internal mammary radiation has a high benefit-to-risk ratio.
authors.affiliation: Nuclear Medicine, Saint-Louis Hospital, University of Paris VII, Paris, France. elif.hindie@sls.aphp.fr
authors.forename: Elif
authors.initials: E
authors.lastname: Hindié
authors.forename: David
authors.initials: D
authors.lastname: Groheux
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brenot-Rossi
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Moretti
authors.forename: Marc
authors.initials: M
authors.lastname: Espié
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000401:mortality*; D011379:Prognosis; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome