Sentinel lymph node (SLN) evaluation is crucial in the diagnosis and prognostic evaluation of breast cancer (BC). The role of SLN -lymphoscintigraphy is well-established in primary operable BC but is less straightforward in case of second primary or relapse BC in the ipsilateral breast, whereas it may spare unnecessary axillary lymph node dissection (ALND). The aim of this study is to evaluate the performance of SNL-lymphoscintigraphy in case of rBC.
SLN-lymphoscintigraphy was performed, collected in 18 months, in 6 consecutive BC patients with second primary or relapse BC. All the patients had been previously treated by conservative surgery and SNL evaluation without ALND.
SLN-lymphoscintigraphy procedures were performed by a nuclear medicine physician using a standard technique. All patients underwent preoperative lymphoscintigraphy on the day before the surgery. A combined periareolar intradermal (on the same quadrant as the tumor location) and peritumoral technique was used for all patients. After an injection of 1,000 Ci of filtered technetium nanocolloid, static planar images were obtained. A hand-held gamma probe was used for identifying the SLN and to determine if there was any non-SLN. All SLNs and non-SLNs were evaluated intra-operatively by touch preparation cytology. When metastases were identified in the SLN, either intra-operatively or through permanent evaluation, axillary dissection was performed.
SLN-lymphoscintigraphy identified SLNs in all the patients. Following SNL biopsies were negative in 5 (84%) and metastatic in 1 patient (16%) who underwent to ALND. Three out of the 5 SLN-lymphoscintigraphy negative patients had one or two additional nodes excised that resulted negative.
SNL-lymphoscintigraphy is a reliable method to evaluate axillary nodes in patient with ipsilateral, second primary or relapse BC and may contribute to the ALND management . A larger series is necessary to confirm this preliminary data.