LYMPH NODE BIOPSY: ONE YEAR EXPERIENCE
A COMMUNITY HOSPITAL IN ITALY.
L, Benzoni C, Alessi G, Amini M, Manni C, Di Nardo A, Crenca F, Bianca S,
Vitelli CE. Department
of Surgical Oncology, Radiology,
Vannini Hospital, Rome – ITALY 00177
Sentinel lymph node (SLN) biopsy is increasingly used as the preferred axillary
staging procedure for women with early breast cancer. PATIENTS
AND METHODS: 68 consecutive women receiving primary treatment of breast
cancer less than 3 cm in diameter were prospectively studied from January
1999 to January 2000 . All patients signed a detailed informed consent.
The majority of patients (85%) underwent a combined technique of intradermal
injection of 0.6-1 mCi of Tc-99 filtered nanocolloid and 1-3 cc of Patent Blue
dye at the biopsy site. Intraoperative localization was performed with a
hand-held gamma probe (Scintiprobe MR100 – Pol.hi.tech, ITALY). Lymph nodes
were analyzed by frozen section or touch-prep, and serially for H/E stain and
IHC. The first 15 patients underwent routine back-up lymphadenectomy to validate
the technique. Thereafter, only patients with positive SLN, suspicious findings,
or personal preference underwent axillary dissection. RESULTS:
The median age was 62 years (range 37-85). The median diameter of the breast
tumor was 1,5 cm (range 0.4-3 cm).
Local anesthesia with sedation was used in 45% of cases. Success rate for
identification of SLN was 94% (64/68 cases). One to 4 sentinel nodes were
identified (median 2). The SLN was hot and blu in 68%, hot only in 22%, and blue
only in 10% of cases. A total of 490 additional lymph nodes were removed after
SLN biopsy (median 6 lymph nodes/patient; range 0-24). Correlation between SLN
and the final axillary status was 97% (62/64
cases). The two false negative SLN were found in the first 18 cases.
There were 20 patients with positive axillary nodes
(29%). In 11 of these, the only positive node was the sentinel lymph node.
Two patients had only microscopic foci of cancer found on serial sectioning or
IHC of the SLN. Forty-two patients
(67%) could have avoided axillary dissection becouse the SLN was found and it
was truly negative. There were four minor complications.
CONCLUSIONS: SLN biopsy
is safe, accurate and easily reproduced. The majority of breast cancer patients
may no longer need routine axillary lymphadenectomy.