Sentinel Lymph Node Biopsy in Breast Cancer Using Radiolabelled Sulfur Colloid

N Lamichhane, KW Shen, QX Han, ZZ Shen, Y Zhang, Z Shao
Department of Breast Surgery
Department of Nuclear Medicine
Affiliated Cancer Hospital, Fu Dan University, Medical Center, Shanghai 200032, China.

Objective

To evaluate the performance and feasibility of sentinel node biopsy in breast cancer patients using technetium-99m sulfur colloid and gamma probe.

Methods

From May to August 2000 at the Affiliated Cancer Hospital, 30 patients with tumour size less than 5 cm and clinically negative axillary lymph nodes underwent sentinel node biopsy followed by standard axillary dissection. Technetium-99m sulfur colloid was injected around the primary tumour and a gamma probe was used to detect the sentinel lymph node during the surgical procedure. Sentinel node biopsy was compared with standard axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes.

Results

The sentinel node was successfully identified in 27 of 30 of patients (90%). The number of sentinel nodes ranged from 1 to 3 (average 1.5) and nonsentinel nodes ranged from 5-20 (average 13.3). Of the 27 patients with sentinel nodes, 52% (14) were histologically positive. The sentinel node was falsely negative in 2 patients, yielding an accuracy of 92.6%. Sentinel node biopsy was more accurate for T1 tumours than for T2 tumours.

Conclusions

The gamma probe guided method is technically feasible for detecting sentinel nodes in most cases, accurately predicting the axillary lymph node status, and appears more accurate for T1 lesions than for larger lesions. This minimally invasive axillary staging procedure represents a major advance in the surgical treatment of breast cancer.

Key words: Axillary dissection; Breast cancer; Sentinel lymph node; Surgical therapy.