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Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes

Authors :
Giuseppe Viale
Viviana Galimberti
Alberto Luini
Stefano Zurrida
Giovanni Paganelli
Alberto Costa
Umberto Veronesi
Paolo Veronesi
Virgilio Sacchini
James Geraghty
Marilia Bedoni
Concetta De Cicco
Source :
Plastic Surgical Nursing. 19:157
Publication Year :
1999
Publisher :
Ovid Technologies (Wolters Kluwer Health), 1999.

Abstract

Summary Background Axillary lymph-node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary nodes are free of disease. This raises questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph node (sentinel node) initially receives malignant cells from a breast carcinoma and, second, whether a clear sentinel node reliably forecasts a disease-free axilla. Methods In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium-99m. This tracer was injected subdermally, close to the tumour site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive node (sentinel node). During breast surgery, a hand-held γ-ray detector probe was used to locate the sentinel node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The sentinel node was tagged separately from other nodes. Permanent sections of all removed nodes were prepared for pathological examination. Findings From the sentinel node, we could accurately predict axillary lymph-node status in 156 (97·5%) of the 160 patients in whom a sentinel node was identified, and in all cases (45 patients) with tumours less than 1·5 cm in diameter. In 32 (38%) of the 85 cases with metastatic axillary nodes, the only positive node was the sentinel node. Interpretation In the large majority of patients with breast cancer, lymphoscintigraphy and γ-probe-guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel-node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease-free.

Details

ISSN :
07415206
Volume :
19
Database :
OpenAIRE
Journal :
Plastic Surgical Nursing
Accession number :
edsair.doi.dedup.....1e7a8946afed445a772b4ad31f771116