Radionuclide-Assisted Sentinel Lymph Node Localization and Biopsy in Management of Early Invasive Breast Cancer

Background: The value of sentinel lymph node(s) [SLN(s)] biopsy rests on the concept that a single lymph node (sentinel node) is the first of a group of lymph nodes that receives drainage of a specific body segment. In theory, by surveying this single node, tumor movement from the primary site can be predicted for the remainder of the lymph node basin. Should the sentinel node be free of tumor, the remaining lymph nodes of the basin are presumed to be negative, and the patient may be spared unnecessary axillary lymph node dissection.Patients and Methods: This study was conducted at 3 different centers during the period from December 2002 till May 2006. The study involved 60 females with early invasive breast cancer OVT2, Clinically Nq, Mq). Localization of SLN(s) was performed by the combination of 3 techniques; preoperative lymphoscintigraphy, and intraoperative isosulfan blue dye mapping and hand-held gamma probe. After localization and excision of sentinel lymph nodes, axillary dissection,as well as, surgical management of the primary tumor was done. The specimens of SLN(s), non-SLN(s), and the primary tumor were examined separately for histopathology. Correlation between SLNs involvement and non-SLN(s) involvement was done. Results: Among the 60 patients with early invasive breast cancer, the overall SLN(s) localization was successful in 90% of cases. The sensitivity, the specificity, the predictive value of positive test, the predictive value of negative test, as well as the accuracy of the histopathological yield of the SLN(s)biopsy were found to be 91.3%, 100%, 100%, 93.9% and 96.3% respectively.Conclusion: SLN(s) localization and biopsy is a good predictor of the histopathological status of axillary lymph nodes and can prevent unnecessary axillary dissection in early stages with node negative invasive breast cancer. The use of lymphoscintigraphy and gamma probe facilitates localizatitidn of SLN(s) and increases its accuracy.