Minder okselklierdissectie nodig door schildwachtklierbiopsie bij patiënten met mammacarcinoom

To determine whether the sentinel node concept is appropriate in patients with breast cancer, notably whether the sentinel node can be identified after peritumoral injection of colloidal ^99mTc albumin using lymphoscintigraphy or a handheld gamma probe in the axillary drainage area.

Design

Descriptive.

Setting

Academic Hospital Free University, Amsterdam, the Netherlands.

Method

In 30 consecutive patients with T1 and T2 breast cancer lymphoscintigraphy was performed 2 and 18 hours after peritumoral injection of 40 MBq of colloidal ^99mTc albumin injection. Focal accumulations in the axilla were registered and localized in vivo using a handheld gamma probe. All patients underwent axillary lymph node dissection. From each surgical specimen the sentinel node was isolated and examined histopathologically.

Results

In 28 of the 30 patients lymphoscintigraphy revealed at least one distinct focal accumulation in the axillary region after 2 and 18 h. In nine women more than one sentinel node was registered: two in six and three in three women. In all 28 patients the node was identified in the surgical specimen by gamma probe. In 19 of the 28 (67) both the sentinel node and the axillary lymph nodes were without metastasis. Three patients had metastases both in the sentinel and in the other axillary nodes, and in 6 patients (21) the sentinel node was the only node with metastasis.

Conclusion

In the majority of breast cancer patients a sentinel node was identified after peritumoral injection of colloidal ^99mTc albumin, and with a handheld gamma probe the node could be found in the surgical specimen. In none of the women metastasis was found in other lymph nodes if the sentinel node was unaffected.