Abstract P1-01-25: Sentinel lymph node biopsy in breast cancer: The approach in day surgery under local anaesthesia for quality-of-life and significant cost reduction

Abstract

Abstract Background: Sentinel lymph node biospy (SLNB) is widely used in the management of breast cancer patients without axillary metastases or inflammatory breast cancer (IBC). Methods: From Jan. 1st 2006 through Dic. 31st 2011 we performed 302 SLNB at St. M. Goretti Hospital. Mammary carcinoma was diagnosed as malignant by aspiration citology and/or biospy. In all cases with positive citology or biospy, we performed quadrantectomy and SLNB at the same time. All patients underwent pre-operative lymphoscintigraphy with intradermal pericicatritial and/or periareola injection of 12–15 MBq 99Tc colloidal albumin particles 50–80 nm size range, in 0,2 ml saline solution. We never used vital blue dye. All patients underwent surgical treatment 3–12 h. later. We performed SLNB and quadrantectomy in day surgery (DS) and local anaesthesia (LA) with 2% of Carbocaine. Axillary incision was 3–4 cm. This study was approved by an ethics committee, was discussed with all patients and informed consent was obtained. Purpose of the study is to investigate the approach in DS under LA for quality of life and significant cost reduction. Results: Six patients underwent pre-operative lymphoscintigraphy the radiotracer did not show any sentinel lymph node (SLN), in five cases we performed axillary dissection (AD). In one case of young patient who had previously been treated with chemotherapy for non-Hodgkin's lymphoma, negative positron emission tomography (PET), we performed quadrantectomy without AD. In three cases the axilla was positive. In four cases of multifocal (MF) and two of multicentric (MC) invasive breast cancer, the SLN was identified in axilla and SLNB was perfomed. SLNB in MF and MC tumors was similar to unifocal cancers. Only one case of MC cancer the SLN was positive. Six patients classified T4b according to AJCC, were treated with neoadjuvant chemotherapy (NC). The axilla was negative to ultrasound (US), PET and citology. After completion of NC, lymphatic mapping was able to identify SLN and we performed SLNB. In these patients SLN was negative. In two cases of male cancer the axilla was negative to clinical examination, in both cases SLN was positive for macrometastases. Six cases showed axillary isolated tumor cells (ITC). Eighteen micrometastases. Thirty-two macrometastases. In two case of negative SLN there was a positive second palpable lymph node. One case showed a double SLN in the axilla and internal mammary chain, only the internal mammary lymph node was positive. The SLN identification rate was 99%. After surgery we distributed a questionnaire to the patients about the acceptability of this approach. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-25.