Lymph Scintigraphy and Pre- and Intraoperative Gamma Prone Measurements for Localization of Sentinel Lymph Nodes (SLN) in Breast Cancer

[Metastases in patients with breast cancer despite of negative sentinel lymph node. Has the concept to be changed?]

The sentinel lymph node (SLN) is of considerable prognostic relevance, because extended lymph node dissection may not be performed in patients presenting with histologically negative SLN. The aim of this study was to prove the prognostic value of the SLN-concept in these patients in long term follow-up.

PATIENTS, METHODS

The clinical follow-up of 202 women with histologically proven breast cancer and metastatically uninvolved (negative) SLN, as determined using Tc-99m-nanocolloid, was observed for a mean period of 43.4 months. Histological examination included standard methods (HE-Test) and special histochemical techniques (antibodies against cytokeratin). All patients underwent clinical examinations and mamography according a standardised schema; other procedures like ultrasound examination, routine blood tests, and chest X-ray scans were performed in patients considered doubtful after clinical examination or mamography.

RESULTS

Despite of negative SLN-findings in 14/202 patients (6.9%) metastases were found after a mean time period of 35.9 months. 4 patients showed local re-lapses, 3 patients presented with regional lymph node recurrences in the previously mapped (negative) SLN-basin, and 7 Patients developed distant metastases outside the primary lymphatic basin.

CONCLUSION

In patients negative on SLN-biopsy the axillary lymph-node-recurrence-rate was low; in 3/202 patients (1.5%) a progression in the SLN-basin could be assessed, being real concept failures. Our results underline that there is no evidence to question this concept in patients presented with clinically metastatically uninvolved early stage of breast cancer.