Impact of axillary nodal metastases on lymphatic mapping and sentinel lymph node identification rate in patients with early stage breast cancer

The aim of this study was to define the impact of the presence of axillary nodal metastases on lymphatic mapping and sentinel lymph node (SLN) identification rate in patients with early breast cancer. Two hundred and forty-six lymphatic mapping procedures were performed with both labelled nanocolloi...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2005-08, Vol.32 (8), p.937-942
Main Authors: Pelosi, Ettore, Ala, Ada, Bellò, Marilena, Douroukas, Anastasios, Migliaretti, Giuseppe, Berardengo, Ester, Varetto, Teresio, Bussone, Riccardo, Bisi, Gianni
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Axilla - diagnostic imaging
Axilla - pathology
Breast Neoplasms - diagnostic imaging
Breast Neoplasms - pathology
Female
Follow-Up Studies
Humans
Lymph Node Excision
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local - diagnostic imaging
Neoplasm Recurrence, Local - pathology
Neoplasm Staging
Radionuclide Imaging
Radiopharmaceuticals
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Sentinel Lymph Node Biopsy - methods
Severity of Illness Index
Technetium Tc 99m Aggregated Albumin
Treatment Outcome
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Summary:The aim of this study was to define the impact of the presence of axillary nodal metastases on lymphatic mapping and sentinel lymph node (SLN) identification rate in patients with early breast cancer. Two hundred and forty-six lymphatic mapping procedures were performed with both labelled nanocolloid and blue dye, followed by SLN biopsy and/or complete axillary dissection. The following parameters were recorded: patient's age, tumour laterality and location, tumour size, tumour histology, tumour stage, tumour grade, lymphovascular invasion, radiotracer injection site (subdermal-peritumoural/peri-areolar), SLN visualisation at lymphoscintigraphy, SLN metastases (presence/absence, size) and other axillary metastases (presence/absence, number). Discriminant analysis was used to analyse the data. SLNs were identified by labelled nanocolloid alone in 94.7% of tumours, by blue dye alone in 93.5% and by the combined technique in 99.2%. Discriminant analysis showed the gamma probe SLN identification rate to be significantly limited by the presence of axillary nodal metastases. In particular, the size of SLN metastases and the number of other axillary metastases were the most important variables in reducing the gamma probe SLN identification rate (p = 0.004 and p = 0.002, respectively). On the other hand, high tumour grade was the only parameter limiting the blue dye SLN identification rate. The accuracy of lymphatic mapping with labelled nanocolloid is limited by the presence of axillary nodal metastases, and particularly by the degree of SLN tumoural invasion and the presence and number of other axillary nodal metastases. Neither of these elements seems to interfere with the blue dye identification rate. The combination of the two tracers maximises the SLN identification rate.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-005-1797-9