HIGH VISUALIZATION AND LOW FALSE NEGATIVE RATE OF
SENTINEL LYMPH NODE BIOPSY
(Ramesh Sarin, Parag Kumar, Uma Ravi Shankar, Sumaid Kaul)
A large number of single and multicentric institutions have used SLN biopsy in clinically node negative early stage breast cancer. There is a wide variation in both identification (86% – 97%) and false negative rates (4% – 16.7%). We present the factors responsible for high success rate in identifications of SLNs and low false negatives from validation study at our institution.
METHODS AND RESULTS
145 patients with clinically node negative early stage breast cancer were enrolled for SLN biopsy followed by axillary dissection. SLNs were localized pre-operatively by injecting 14-18 MBq Tc 99m nano Sized colloidal albumin intradermally around the tumor 4-18 hrs before surgery. SPECT scintimammogrphy was performed after 30mts and up to 4 hrs till the visualization of SLN. 5ml of 1% vital dye was injected periareolar subdermally 8-15 minutes prior to incision. SLN recovery was made with diligent search by senior by senior consultant, nuclear medicine & surgical oncology. All hot and or blue nodes were removed along with suspicious palpable nodes and sent for frozen section. Reporting was according to ASCO-CAP guidelines.
Age Group 26years to 86 years
Mean Age: 54.8
< 35yrs of age: 7(5%)
>35yrs of age: 138(95%)
T0 : 01(0.71%)
T1 : 44 (31.21%)
T2 : 95(67.37%)
T3 : 01(0.71%)
Mean no. of sentinel nodes dissected 3.33
Range from 1 to 7
Increasing the mean no. of sentinel nodes removed improved accuracy
(NSABP B-32 Trial showed that first 2-3 nodes removed predicted the status of axillia in 98% of the cases)
STATUS OF SENTINEL NODE POSTIVITY & TUMOR SIZE
PT0 Negative Sent Node: 1
PT1 Negative Sentinel Nodes: 20(45.5%)
Positive Sentinel Nodes: 24(55.5%)
PT2 Negative Sentinel Nodes: 44(46.3%)
PT3 Negative Sentinel Nodes: 1
42 (61.8%) of 68 patients with histological positive SLNs showed positivity only in SLNs.
Hot & Blue 121(85.8%)
Either Blue or Hot 20(14.2%)
Not Detected 4
High success rate in detecting SLNs in our validation study was due to triple methods of localization – radio colloid injection, pre-operative SPECT CT lymphoscientigraphy, vital blue dye coupled with diligent search. Harvesting more than two SLNs helps in lowering the false negative rate. Pro- operative SPECT CT imaging was responsible high identification rate.
Gurbe BJ, Gluliano AE, Adv surg 2004; 38-121-166 : Clarke D. San Antanio, Texas, 2001: Zavagno G, DebsalvoGLScalco G et al. Ann Surg 2005; 241:48-54: Goyal A Newcombe R Chhabra A et al. Breast Cancer Res treat 2006;99:203-208.
Apollo Cancer institute, Indraprastha Apollo Hospital, New DelhiThis data was provided by Dr Ramesh Sarin & Ms Janani