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Objectives: To determine feasibility and accuracy of SLN biopsy in locally advanced breast cancer treated by neoadjuvant chemotherapy., Materials and Methods: From April 2001 to December 2004, a prospective series was constituted of 74 women with invasive breast carcinoma T1T2T3N0N1 receiving neoadjuvant chemotherapy. The SLN located was removed using subdermal periareolar injection of radiolabelled nanocolloid and axillary lymph node dissection was systematically performed., Results: A SLN was identified in 68/74 (92%) patients. It was metastatic in 30/68 cases (44%). The false negative (FN) rate was 14% (5/35). In the subgroup of 42 patients clinically N(0) before chemotherapy, accuracy was 100 %, and FN rate 0%, in the 32 N1, accuracy was 83%, and FN rate 25%., Conclusions: SLN biopsy using a single subdermal injection of radiolabelled nanocolloid in patients with a breast cancer treated by neoadjuvant chemotherapy is technically feasible and appears to be highly accurate in the subgroup of patients with a clinically negative axilla breast cancer before treatment.

The isotopic detection of the sentinel node is undergoing a fast development in breast cancer and melanoma. It requires a good collaboration between a surgeon and a nuclear medicine specialist. Although the method is now well defined for melanoma, several options remain possible for breast cancer. The injected dose and volume can differ between centers, as well as the sites of injection in terms of their number, anatomical location and depth. However, since all options seem to provide equivalent results, a single intradermal periareolar injection could be the preferred choice. The role of imaging remains controversial, but it provides a definite complementary information, in particular in case of an unusual location of the sentinel node. The addition of dye injection also adds to the results. The optimal use of a peroperative hand-held gamma probe requires some training for the surgeon. A good selection of the indications is essential for a successful detection. Other fields of application are under investigation such as colon cancer, head and neck tumors, lung and prostate cancers. By avoiding a majority of the routine axillary lymph nodes dissections in small breast cancer, the isotopic detection of the sentinel node should dramatically decrease the morbidity of axillary staging and the duration of hospital stay for the patients.