Results of a standardized protocol for sentinel node imaging in breast cancer with Tc-99m labeled nanocolloidal albumin

 

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Summary

Aim of this study was to evaluate the results of o standardized protocol for sentinel node (SN) detection in breast cancer using Tc-99m labeled nanocolloidal albumin and a combined intra- and subdermal injection technique. Methods: One hundred and fifty-five women with proven breast cancer (disease stages Tis-T2) were included. Four injections of 10 to 15 MBq of Tc-99m nanocolloid in 0.1 ml physiologic saline were administered intra- and subdermally at the 3,6,9 and 12 o’clock positions in the skin overlying the tumor. Planar scintigraphic images in lateral and anterior projections were obtained once between 2.5 and 18 hours after tracer administration. Guided by a gamma probe, all radioactive lymph nodes in the axilla were resected, then complete dissection followed. Results: In 151 of the 155 women (97.4%), nodal tracer uptake (range 1-7 foci, average 2.2) was scinligraphically revealed. In one of these cases, drainage was only to the internal mammary lymphatic chain. Three of the 4 women with detection failure presented with histologically proven tumor infiltration of the lymphatics and axillary involvement. In 49 of the patients with visualized axillary lymph nodes (32.7%), at least one SN was metastatic. In 21 cases, this SN was the only positive node. The remaining 101 patients with negative SN included 4 cases with axillary involvement. The sensitivity of the SN with respect to the histological status of the entire axilla was thus 92.5%, the negative predictive value was 96.0%. The overall accuracy of the method was 97.3%. There was a significant difference between the number of totally detected radioactive nodes in the groups with and without nodal metastases (3.49 vs. 2.57, p <0.01). Conclusion: The described protocol represents an easy reproducible and reliable method for SN detection in breast cancer that additionally allows flexible timing of surgery. Further, we found evidence that the number of scinligraphically visualized nodes also reflects the histological status of the axilla.

Zusammenfassung

Ziel dieser Studie war die Evaluierung der Ergebnisse eines standardisierten Protokolls zur Darstellung des Sentinel Node (SN) bei Mammakarzinomen unter Verwendung einer kombinierten intra- und subkutanen Injektionstechnik. Methoden: Insgesamt wurden 155 Patientinnen mit Mammakarzinom im Stadium Tis-T2 untersucht. Vier Injektionen mit jeweils 10-15 MBq Tc-99m-markiertem Nanocoll wurden intra- und subkutan in den Rondbereich der Haut über dem Tumor appliziert. Planare Szintigramme in lateraler und ventraler Sicht erfolgten zwischen 2,5 und 18 Stunden p. i. Nach genauer Lokalisation mit einer Gammasonde wurden intraoperativ zunächst alle radioaktiven Lymphknoten reseziert, danach folgte die komplette Axilladissektion. Ergebnisse: In 151 der 155 Fälle (97,4%) stellten sich szintigraphisch jeweils ein oder mehrere SN dar (insgesamt zwischen 1 und 7 LK, Mittelwert 2,2). In einem dieser Fälle erfolgte der Abfluss ausschließlich in die parasternale Lymphknotengruppe. Bei 3 der 4 Patientinnen ohne detektierbaren Lyrnphabfluss fand sich histologisch eine Tumorinfiltration der Lymphbahnen mit axillärer Metastasierung. Bei 49 der Frauen mit axillärem Lyrnphabfluss (32,7%) zeigte sich histologisch zumindest ein positiver SN. In 21 Fällen war dies der einzige befallene LK. Von den übrigen 101 Patientinnen mit negativen SN fand sich in 4 Fällen eine axilläre Metastasierung. Die Sensitivität des SN zur Vorhersage des Nodalstatus errechnet sich somit zu 92,5%, der negative prädiktive Wert zu 96,0% und die Genauigkeit zu 97,3%. Darüber hinaus zeigte sich ein signifikanter Unterschied zwischen der Zahl der insgesamt detektierten radioaktiven LK in der Gruppe mit bzw. ohne axilläre Metastasierung (3,49 vs. 2,57, p <0,01). Schlussfolgerung: Das beschriebene Protokoll stellt eine leicht reproduzierbare und zuverlässige Methode zur SN-Detektion dar. Ferner konnte gezeigt werden, daß die Anzahl der szintigraphisch nachweisbaren Lymphknoten auch Hinweise auf den Nodalstatus gibt.

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