title: Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumour response.
abstract: OBJECTIVE
  Our objective was to analyse the accuracy of the sentinel node biopsy, taking into consideration the scintigraphy detection rate after the intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy.
  
  
  METHODS
  The study included 60 patients with a diagnosis of invasive breast carcinoma, stage T1-T3, who received treatment with neoadjuvant chemotherapy, and were subsequently subjected to breast surgery and sentinel node biopsy after intra-tumour administration of the radiopharmaceutical.
  
  
  RESULTS
  Scintigraphic detection of some sentinel node was achieved in 55/60 patients (91.6%). When those cases that received a second injection of the radiopharmaceutical, performed peri-areolarly due to a lack of tracer migration, were excluded, the detection rate dropped to 70% (42/60). When the detection of sentinel node, or its absence, was compared in those 42 patients, no differences were found with age, laterality-location of the lesion, size pre- and post-neoadjuvant chemotherapy, histological grade, or immunohistochemical profile. There were significant differences when comparing the groups according to the degree of pathological tumour response, both with the Miller-Payne system (non-detection 44.4%-detection 16.7%, p = 0.003) as well as the residual cancer burden (72.2%-28.6%, p<0.01).
  
  
  CONCLUSIONS
  The scintigraphic detection of the sentinel node after intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy was below the optimal value, and sometimes a further, peri-areolar, injection was necessary, probably in relation to an alteration in the lymphatic drainage pathways. There was a significant inverse relationship between the detection of the sentinel node and level of pathological tumour response.
authors.affiliation: Facultativo especialista, Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España. Electronic address: rafixdiaz@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Díaz-Expósito
authors.affiliation: Facultativo especialista, Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: L
authors.initials: L
authors.lastname: Martí-Bonmatí
authors.affiliation: Facultativo especialista, Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: O
authors.initials: O
authors.lastname: Burgués
authors.affiliation: Facultativo especialista, Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: I
authors.initials: I
authors.lastname: Casáns-Tormo
authors.affiliation: Facultativo especialista, Servicio de Oncología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: B
authors.initials: B
authors.lastname: Bermejo-de Las Heras
authors.affiliation: Facultativo especialista, Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: A
authors.initials: A
authors.lastname: Julve-Parreño
authors.affiliation: Facultativo especialista, Servicio de Cirugía General, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: A
authors.initials: A
authors.lastname: Caballero-Garate
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage*
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
keywords: Biopsia ganglio centinela; Breast cancer; Cáncer de mama; Detección gammagráfica; Neoadjuvant chemotherapy; Quimioterapia neoadyuvante; Scintigraphic detection; Sentinel node biopsy