Download PDF
Nuklearmedizin 2001; 40(03): 80-85
DOI: 10.1055/s-0038-1623875
Originalarbeiten – Original Articles
Schattauer GmbH

Results of a standardized protocol for sentinel node imaging in breast cancer with Tc-99m labeled nanocolloidal albumin

Ergebnisse eines standardisierten Protokolls zur Darstellung des Sentinel Node bei Mammokarzinomen mit Tc-99m-markiertem Nanocoll
T. Rink
1   Department of Nuclear Medicine, Municipal Hospital, Hanau, Germany
,
T. Heuser
2   Department of Gynecology, Municipal Hospital, Hanau, Germany
,
H. Fitz
3   Department of Pathology, Municipal Hospital, Hanau, Germany
,
H.-J. Schroth
1   Department of Nuclear Medicine, Municipal Hospital, Hanau, Germany
,
E. Weller
2   Department of Gynecology, Municipal Hospital, Hanau, Germany
,
H. H. Zippel
2   Department of Gynecology, Municipal Hospital, Hanau, Germany
› Author Affiliations
Further Information

Publication History

Reserved: 31 August 2000

17 October 2000

Publication Date:
10 January 2018 (online)

Also available at
    Permissions and Reprints

Summary

Aim of this study was to evaluate the results of o standardized protocol for sentinel node (SN) detection in breast cancer using Tc-99m labeled nanocolloidal albumin and a combined intra- and subdermal injection technique. Methods: One hundred and fifty-five women with proven breast cancer (disease stages Tis-T2) were included. Four injections of 10 to 15 MBq of Tc-99m nanocolloid in 0.1 ml physiologic saline were administered intra- and subdermally at the 3,6,9 and 12 o’clock positions in the skin overlying the tumor. Planar scintigraphic images in lateral and anterior projections were obtained once between 2.5 and 18 hours after tracer administration. Guided by a gamma probe, all radioactive lymph nodes in the axilla were resected, then complete dissection followed. Results: In 151 of the 155 women (97.4%), nodal tracer uptake (range 1-7 foci, average 2.2) was scinligraphically revealed. In one of these cases, drainage was only to the internal mammary lymphatic chain. Three of the 4 women with detection failure presented with histologically proven tumor infiltration of the lymphatics and axillary involvement. In 49 of the patients with visualized axillary lymph nodes (32.7%), at least one SN was metastatic. In 21 cases, this SN was the only positive node. The remaining 101 patients with negative SN included 4 cases with axillary involvement. The sensitivity of the SN with respect to the histological status of the entire axilla was thus 92.5%, the negative predictive value was 96.0%. The overall accuracy of the method was 97.3%. There was a significant difference between the number of totally detected radioactive nodes in the groups with and without nodal metastases (3.49 vs. 2.57, p <0.01). Conclusion: The described protocol represents an easy reproducible and reliable method for SN detection in breast cancer that additionally allows flexible timing of surgery. Further, we found evidence that the number of scinligraphically visualized nodes also reflects the histological status of the axilla.

Zusammenfassung

Ziel dieser Studie war die Evaluierung der Ergebnisse eines standardisierten Protokolls zur Darstellung des Sentinel Node (SN) bei Mammakarzinomen unter Verwendung einer kombinierten intra- und subkutanen Injektionstechnik. Methoden: Insgesamt wurden 155 Patientinnen mit Mammakarzinom im Stadium Tis-T2 untersucht. Vier Injektionen mit jeweils 10-15 MBq Tc-99m-markiertem Nanocoll wurden intra- und subkutan in den Rondbereich der Haut über dem Tumor appliziert. Planare Szintigramme in lateraler und ventraler Sicht erfolgten zwischen 2,5 und 18 Stunden p. i. Nach genauer Lokalisation mit einer Gammasonde wurden intraoperativ zunächst alle radioaktiven Lymphknoten reseziert, danach folgte die komplette Axilladissektion. Ergebnisse: In 151 der 155 Fälle (97,4%) stellten sich szintigraphisch jeweils ein oder mehrere SN dar (insgesamt zwischen 1 und 7 LK, Mittelwert 2,2). In einem dieser Fälle erfolgte der Abfluss ausschließlich in die parasternale Lymphknotengruppe. Bei 3 der 4 Patientinnen ohne detektierbaren Lyrnphabfluss fand sich histologisch eine Tumorinfiltration der Lymphbahnen mit axillärer Metastasierung. Bei 49 der Frauen mit axillärem Lyrnphabfluss (32,7%) zeigte sich histologisch zumindest ein positiver SN. In 21 Fällen war dies der einzige befallene LK. Von den übrigen 101 Patientinnen mit negativen SN fand sich in 4 Fällen eine axilläre Metastasierung. Die Sensitivität des SN zur Vorhersage des Nodalstatus errechnet sich somit zu 92,5%, der negative prädiktive Wert zu 96,0% und die Genauigkeit zu 97,3%. Darüber hinaus zeigte sich ein signifikanter Unterschied zwischen der Zahl der insgesamt detektierten radioaktiven LK in der Gruppe mit bzw. ohne axilläre Metastasierung (3,49 vs. 2,57, p <0,01). Schlussfolgerung: Das beschriebene Protokoll stellt eine leicht reproduzierbare und zuverlässige Methode zur SN-Detektion dar. Ferner konnte gezeigt werden, daß die Anzahl der szintigraphisch nachweisbaren Lymphknoten auch Hinweise auf den Nodalstatus gibt.

Keywords

Breast cancer - sentinel node - lymphoscintigraphy - gamma probe - nanocolloidal albumin

Schlüsselwörter

Mammakarzinom - Sentinel Node - Lymphabfluss-Szintigraphie - Gammasonde - Nanokolloid
 

  • References

  • 1 Albertini JJ, Lyman GH, Cox C. et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996; 276: 1818-22.
    CrossrefPubMedGoogle Scholar
  • 2 Borgstein PJ, Pijpers R, Comans EF. et al. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998; 186: 275-83.
    CrossrefPubMedGoogle Scholar
  • 3 Brenner W, Osterlag H, Czech U. et al. Lymph scintigraphy and pre- and intraoperative gamma probe measurements for localization of sentinel lymph nodes (SLN) in breast cancer. Nuklearmedizin 2000; 39: 82-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977; 39: 456-66.
    CrossrefPubMedGoogle Scholar
  • 5 De Cicco C, Chinol M, Paganelli G. Intraoperative localization of the sentinel node in breast cancer: technical aspects of lymphoscintigra-phic methods. Semin Surg Oncol 1998; 15: 268-71.
    CrossrefPubMedGoogle Scholar
  • 6 De Cicco C, Cremonesi M, Luini A. et al. Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 1998; 39: 2080-4.
    PubMedGoogle Scholar
  • 7 Grant RN, Tabah EJ, Adair FE. The surgical significance of the subareolar lymph plexus in cancer of the breast. Surgery 1953; 33: 71-8.
    PubMedGoogle Scholar
  • 8 Hultborn KA, Larsson LG, Ragnhult I. The lymph drainage from the breast to the axillary and parasternal lymph nodes, studies with the aid of colloidal 198-Au. Acta Radiol 1955; 43: 52-64.
    PubMedGoogle Scholar
  • 9 Kaplan WD, Andersen JW, Siddon RL. et al. The three-dimensional localization of internal mammary lymph nodes by radionuclide lymphoscintigraphy. J Nucl Med 1988; 29: 473-8.
    PubMedGoogle Scholar
  • 10 Kapteijn BA, Nieweg OE, Muller SH. et al. Validation of gamma probe detection of the sentinel node in melanoma. J Nucl Med 1997; 38: 362-6.
    PubMedGoogle Scholar
  • 11 Keramopoulos A, Tsionou C, Minaretzis D. et al. Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach. Oncology 1993; 50: 445-9.
    CrossrefPubMedGoogle Scholar
  • 12 Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2: 335-9.
    CrossrefPubMedGoogle Scholar
  • 13 Krag D, Weaver D, Ashikaga T. et al. The sentinel node in breast cancer - a multicenter validation study. N Engl J Med 1998; 339: 941-6.
    CrossrefPubMedGoogle Scholar
  • 14 Lin PP, Allison DC, Wainstock J. et al. Impact of axillary lymph node dissection on the therapy of breast cancer patients. J Clin Oncol 1993; 11: 1536-44.
    CrossrefPubMedGoogle Scholar
  • 15 Munz DL, Maza S, Ivancevic V, Geworski L. Classification of the lymphatic drainage status of a primary tumor: a proposal. Nuklearmedizin 2000; 39: 88-91.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Paganelli G, De Cicco C, Cremonesi M. et al. Optimized sentinel node scintigraphy in breast cancer. Q J Nucl Med 1998; 42: 49-53.
    PubMedGoogle Scholar
  • 17 Pijpers R, Meijer S, Hoekstra OS. et al. Impact of ¡ymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer. J Nucl Med 1997; 38: 366-8.
    PubMedGoogle Scholar
  • 18 Reuhl T, Haensch W, Markwardt J, Schlag PM. Sentinel lymph node detection in patients with breast carcinoma. Zentralbl Chir 1998; 123 (Suppl 5): 72-4.
    PubMedGoogle Scholar
  • 19 Roumen RM, Geuskens LM, Valkenburg JG. In search of the true sentinel node by different injection techniques in breast cancer patients. Eur J Surg Oncol 1999; 25: 347-51.
    CrossrefPubMedGoogle Scholar
  • 20 Roumen RM, Valkenburg JG, Geuskens LM. Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer. Eur J Surg Oncol 1997; 23: 495-502.
    CrossrefPubMedGoogle Scholar
  • 21 Sullivan DC, Croker Jr BP, Harris CC. et al. Lymphoscintigraphy in malignant melanoma: 99mTc antimony sulfur colloid. Am J Roentgenol 1981; 137: 847-51.
    CrossrefPubMedGoogle Scholar
  • 22 Tobin MB, Lacey HJ, Meyer L, Mortimer PS. The psychological morbidity of breast cancer-related arm swelling. Psychological morbidity of lymphoedema. Cancer 1993; 72: 3248-52.
    CrossrefPubMedGoogle Scholar
  • 23 Turner-Warwick RT. The lymphatics of the breast. Br J Surg 1959; 46: 574-82.
    CrossrefPubMedGoogle Scholar
  • 24 Uren RF, Howman-Giles RB, Thompson JF. et al. Mammary lymphoscintigraphy in breast cancer. J Nucl Med 1995; 36: 1775-80.
    PubMedGoogle Scholar
  • 25 Veronesi U, Paganelli G, Víale G. et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91: 368-73.
    CrossrefPubMedGoogle Scholar
  • 26 Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph node detection - an overview. Eur J Nucl Med 1999; 26 Suppl. S36-42.
    CrossrefPubMedGoogle Scholar