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Sentinel Lymph Node Mapping for Breast Cancer: Analysis in a Diverse Patient Group¹

¹ From the Division of Nuclear Medicine (J.F.E., D.A.M., L.K.D.) and the Department of Surgery (D.R.B., B.O.A., R.S.Y., R.E.M.), University of Washington Medical Center, Box 356113, Seattle, WA 98195-6113. Received September 10, 1998; revision requested October 26; final revision received February 24, 1999; accepted April 6. Supported in part by grant CA72064 from the National Institutes of Health. Address reprint requests to J.F.E.

PURPOSE: To evaluate sentinel lymph node mapping in patients with breast cancer.

MATERIALS AND METHODS: Sixty-two patients with breast cancer scheduled to undergo axillary nodal dissection underwent scintigraphic localization of sentinel lymph nodes with filtered technetium 99m sulfur colloid. At surgery, isosulfan blue was injected. Sentinel nodes were identifiable by blue color and by radioactivity with hand-held gamma probe. Results were analyzed statistically.

RESULTS: A sentinel lymph node was identified in 49 patients (79%). Lymph nodes were positive for metastatic disease in 26 patients (42%). The mapping success rate was 78% (n = 21) in the 27 patients with no prior surgery, 78% (n = 18) in the 23 patients with prior surgery, and 86% (n = 12) in the 14 patients with prior chemotherapy. Axillary nodes were positive in 11 (41%) of the 27 patients with no prior intervention, six (26%) of the 23 patients with prior surgery, and 10 (71%) of the 14 patients with prior chemotherapy. There were no false-negative findings in patients without prior intervention. Four patients with positive nodes had false-negative sentinel nodes.

CONCLUSION: Sentinel lymph node mapping and biopsy without axillary dissection is appropriate in patients with breast cancer who have not undergone prior intervention. Further study is necessary to ascertain the accuracy of the procedure for patients who have undergone presurgical chemotherapy or previous excisional biopsy.

Index terms: Breast neoplasms, 00.32 • Lymphatic system, neoplasms, 997.33 • Lymphatic system, radionuclide studies, 00.12961

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