Abstract
BackgroundTo evaluate whether tumor localization and method of preoperative biopsy affect sentinel lymph node (SLN) detection after periareolar nuclide injection in breast cancer patients.Methods and Findings767 breast cancer patients were retrospectively included. For lymphscintigraphy periareolar nuclide injection was performed and the SLN was located by gamma camera. Patient and tumor characteristics were correlated to the success rate of SLN mapping. SLN marking failed in 9/61 (14.7%) patients with prior vacuum-assisted biopsy and 80/706 (11.3%) patients with prior core needle biopsy. Individually evaluated, biopsy method (p = 0.4) and tumor localization (p = 0.9) did not significantly affect the SLN detection rate. Patients with a vacuum-assisted biopsy of a tumor in the upper outer quadrant had a higher odds ratio of failing in SLN mapping (OR 3.8, p = 0.09) compared to core needle biopsy in the same localization (OR 0.9, p = 0.5).ConclusionsTumor localization and preoperative biopsy method do not significantly impact SLN mapping with periareolar nuclide injection. However, the failure risk tends to rise if vacuum-assisted biopsy of a tumor in the upper outer quadrant is performed.
Highlights
The occurrence of axillary lymph node metastases in breast cancer patients is an important prognostic factor and has relevant impact on treatment decisions [1,2,3,4]
Multifocal or multicentric disease was found in 134/767 (17.4%) patients. 175/767 (22.8%) patients had axillary lymph node metastases. 61/ 767 (8.0%) patients underwent vacuum-assisted biopsy and 706/767 (92.0%) patients underwent ultrasound-guided core needle biopsy for histopathological proof of the tumour
Overall 678 of 767 patients had a sufficient nuclide uptake resulting in a sentinel lymph node (SLN) detection rate of 88.4%
Summary
The occurrence of axillary lymph node metastases in breast cancer patients is an important prognostic factor and has relevant impact on treatment decisions [1,2,3,4]. Lymphoscintigraphy can be successfully used to map sentinel lymph nodes providing detection rates of 85–98% [5,6,7,8]. Over the last years continuous changes in the technical performance of sentinel lymph node mapping (SLNM) have been introduced. One of those changes was the shift from a peritumoural towards a periareolar nuclide injection. In case the sentinel lymph node (SLN) failed to be recognized and additional intraoperative blue dye injection is unsuccessful surgeons have to consider an axillary dissection for nodal staging. To evaluate whether tumor localization and method of preoperative biopsy affect sentinel lymph node (SLN) detection after periareolar nuclide injection in breast cancer patients
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