Impact of previous surgery on sentinel lymph node mapping: Hybrid SPECT/CT before and after a unilateral diagnostic breast excision.
BACKGROUND
Earlier studies have shown conflicting results regarding the accuracy of sentinel lymph node biopsy after previous breast surgery, especially after a surgical biopsy.


OBJECTIVE
To compare lymph drainage patterns before and after a diagnostic unilateral surgical biopsy using the exact anatomical localisation of sentinel lymph nodes defined by SPECT/CT.


METHODS
Thirty-seven women planned for unilateral surgical excision of an unsuspicious breast lesion were prospectively examined between September 2011 and January 2015. Hybrid SPECT/CT lymphoscintigraphy of the thorax and neck region with bilateral subareolar injections of99mTc-Nanocoll was performed one week before and six weeks after surgery. The non-operated side served as a control. The primary outcome measure was the concordance between pre- and postoperative number and localisation of sentinel lymph nodes.


RESULTS
Sentinel lymph node detection rate with SPECT/CT on operated sides was 91.9 per cent (34 of 37 procedures), to be compared with a detection rate of 93.7 per cent on all non-operated sides (104 of 111 procedures, P = 0.771). Partial or total concordance regarding the localisation and number of sentinel lymph nodes was 85.7 per cent (30 out of 35) on operated and 88.9 per cent (32 out of 36 patients) on non-operated breast sides (P = 0.735).


CONCLUSIONS
Breast surgery slightly decreased the concordance between pre- and postoperative sentinel lymph nodes, but this finding was not statistically significant. Our results thus support that it is feasible to perform a sentinel lymph node biopsy after previous breast excisional surgery with an acceptable level of safety.
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden; Department of Surgery, Södersjukhuset, 118 83 Stockholm, Sweden. Electronic address: linda.holmstrand-zetterlund@sodersjukhuset.se.
Linda
L
Zetterlund
Department of Clinical Science, Intervention and Technology, Division of Radiography, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Stefan
S
Gabrielson
Department of Clinical Science, Intervention and Technology, Division of Radiography, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Rimma
R
Axelsson
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Breast and Endocrine Surgery, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden.
Jana
J
de Boniface
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Breast and Endocrine Surgery, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden.
Jan
J
Frisell
Department of Medical Physics, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
Annie
A
Olsson
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden; Department of Surgery, Södersjukhuset, 118 83 Stockholm, Sweden.
Fuat
F
Celebioglu
D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla; D001706:Biopsy / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000473:pathology / Q000601:surgery; D005260:Female; D018226:Fibroadenoma / Q000473:pathology / Q000601:surgery*; D005348:Fibrocystic Breast Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006965:Hyperplasia; D061305:Lymphoscintigraphy; D042361:Mammary Glands, Human / Q000473:pathology / Q000601:surgery; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D010212:Papilloma / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D013668:Technetium Tc 99m Aggregated Albumin; D055815:Young Adult
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
Axilla; Breast cancer; Excisional biopsy; Sentinel lymph node biopsy; Single-photon emission computed tomography/computed tomography