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Introduction: Intratumoral injection of nanocolloid for lymphatic mapping enables therapeutic excision of clinically occult breast cancer with the aid of a gamma ray detection probe., Objective: The aim of this study was to determine the success rate of radioguided tumor excision in addition to a guide wire and to identify factors predicting clear margins., Material and Methods: Sixty five consecutive patients with invasive occult breast cancer underwent radioguided tumor excision after intratumoral injection of 99 mTc-nanocolloid guided by ultrasound or stereotaxis. A localization wire was inserted; subsequently scintigraphy was performed (group 1). Results were compared with retrospective data from 67 consecutive patients who underwent therapeutic wire-directed excision alone (group 2). Factors predicting clear margin (>1 mm) were determined in a logistic regression model., Results: Adequate margins were obtained in 83 (group 1) and 64% (group 2; p = 0.014) respectively. The invasive component was performed in 4 and 14 patients, respectively. Factors predictive of clear margins were decreasing pathologic tumor diameter (p = 0.035), increasing weight of specimen (p = 0.046), absence of micro-calcifications (p = 0.004), and absence of carcinoma in situ component (p = 0.024). Radioguided excision was an independent predictor of complete excision of the invasive component (p = 0.012)., Conclusions: Application of radioguided surgery combined with wire localization seems to improve outcome of therapeutic excision of non-palpable invasive breast cancer compared to wire-directed excision alone.

The trend to implement sentinel node biopsy as standard of care in patients with clinically localized melanoma is encouraged by the following three factors: the technique of lymphatic mapping has matured to the point that consensus was reached on how the procedure should be carried out, surgeons showed that they can find the node in nearly 100% of patients, and tumor-status was shown to be the most powerful prognostic factor. However, recent studies revealed unfavorable new information that questions the wisdom of this trend. Three studies published in 2001 with a combined total of 1,851 patients show false-negative rates of 16-25%. Another unnerving finding is the 13-19% incidence of in-transit metastases in patients with a tumor-positive sentinel node, reported by three groups. The ultimate purpose of lymphatic mapping is to provide sentinel node positive patients with early therapeutic measures, such as regional node dissection and adjuvant systemic treatment. However, there is currently no evidence that this approach results in improved regional control and survival. Sentinel node biopsy can only become part of routine patient management if the tumor-status of the sentinel node carries clear implications of proven benefit for the manner in wich patients are managed and if regional control is not jeopardized.