Identification of Sentinel Lymph Node in Stage I???II Breast Cancer With Lymphoscintigraphy and Surgical Gamma Probe: Comparison of Tc-99m MIBI and Tc-99m Sulfur Colloid

Abstract

To evaluate the efficacy of the surgical gamma probe (SGP) after peritumoral injection of Tc-99m MIBI and filtered Tc-99m sulfur colloid (SC) in sentinel lymph node (SLN) detection in stage I and II breast cancer for deciding on the need for axillary dissection. Thirty patients with stage I-II breast cancer had peritumoral injection of Tc-99m MIBI (74 MBq/0.2 mL [2 mCi/0.2 mL] at 4 different locations) and 42 different patients had peritumoral injection of filtered Tc-99m sulfur colloid (50 MBq/0.2 mL [1.3 mCi/0.2 mL] at 4 different locations). Anterior, lateral, and anterolateral spot images were acquired at 10, 30, 45, 60, and 120 minutes and 24 hours are injection in 5 patients. During surgery, counts were obtained from the injection site, affected breast tissue, internal mammary, axillary, and supraclavicular regions and the contralateral side using the gamma probe. Peritumoral blue dye was also injected during surgery. The first lymph nodes with counts at least twice the background tissue and/or with blue dye uptake were surgically isolated. Modified radical mastectomy and axillary dissection were performed. Histopathologic evaluation was made on SLN and other excised tissues. In the Tc-99m sulfur colloid group, lymphatic drainage and lymph nodes were demonstrated with lymphoscintigraphy in 31 of 42 patients. SLN was detected by SGP in 35 of 42 patients. In the Tc-99m MIBI group, lymphatic drainage and lymph nodes were visualized with lymphoscintigraphy in 23 of 30 patients. SLN was detected in 25 of 30 patients with SGP in this group. In patients with stage I-II breast cancer, SLN could be successfully demonstrated with lymphoscintigraphy and SGP by the peritumoral injection of filtered Tc-99m sulfur colloid and Tc-99m MIBI.