Background: Intraoperative analysis of the sentinel lymph node (SLN) status is currently performed in patients with breast cancer (BC) undergoing surgery, although the axillary nodes (AN) do not contain metastases in 60% of all patients. The aim of this study was to evaluate the usefulness of 99mTc-sestamibi scintimammography (SSM), axillary ultrasonography (US) and US-guided fine-needle aspiration cytology (FNAC) together in detecting axillary metastases, and their potential role in reducing the number of SLN procedures. Patients and Methods: A series of 86 consecutive women (median age 53 years, range 34-70) with confirmed BC and clinically negative nodes (T1N0) underwent both SSM and US prior to surgery. Sonographic signs of malignancy were considered replacement of echogenic central sinus by hypoechoic tissue, and eccentric thickening of the cortical region with humps on the profile of the AN. A longitudinal-to-transverse ratio higher than 2, corresponding to oval shape of the node, was considered sign of benignity. US-guided FNAC was performed in all patients with suspicious AN on US, or positive SSM and ultrasonographically visualized enlarged nodes. A combined method using radioisotope and blue dye was used for SLN biopsy. The procedure was omitted in patients (N=14, 16.3%) with FNAC suggesting AN metastases, and thus they underwent level I-II axillary dissection, as well as those (8 out of 72, 11.1%) with positive SLN biopsy on frozen section. Results: Final pathology showed 4 pT1bN0, 1 pT1bN1, 60 pT1cN0, and 21 pT1cN1 BC. AN metastases was confirmed in all patients with positive FNAC. The sensitivity, specificity, and accuracy were 59.1%, 93.7%, and 84.9% for SSM, 63.6%, 90.6%, and 83.7% for US, and 72.7%, 97.8%, and 90.7% for SSM and US together. However, the results did not differ significantly (p=NS, chi-squared test). Conclusions: In patients with BC, preoperatively selected by SSM and US, in whom US-guided axillary FNAC has shown the presence of AN metastases, the SLN biopsy can be avoided, and AN dissection should be the primary procedure.

Usefulness of combined sestamibi scintimammography, axillary ultrasonography and FNA cytology in reducing the number of sentinel lymph node procedures in patients with breast cancer

LUMACHI, FRANCO;TREGNAGHI, ALBERTO;CECCHIN, DIEGO;BUI, FRANCO;MARZOLA, MARIA CRISTINA;ZUCCHETTA, PIETRO
2007

Abstract

Background: Intraoperative analysis of the sentinel lymph node (SLN) status is currently performed in patients with breast cancer (BC) undergoing surgery, although the axillary nodes (AN) do not contain metastases in 60% of all patients. The aim of this study was to evaluate the usefulness of 99mTc-sestamibi scintimammography (SSM), axillary ultrasonography (US) and US-guided fine-needle aspiration cytology (FNAC) together in detecting axillary metastases, and their potential role in reducing the number of SLN procedures. Patients and Methods: A series of 86 consecutive women (median age 53 years, range 34-70) with confirmed BC and clinically negative nodes (T1N0) underwent both SSM and US prior to surgery. Sonographic signs of malignancy were considered replacement of echogenic central sinus by hypoechoic tissue, and eccentric thickening of the cortical region with humps on the profile of the AN. A longitudinal-to-transverse ratio higher than 2, corresponding to oval shape of the node, was considered sign of benignity. US-guided FNAC was performed in all patients with suspicious AN on US, or positive SSM and ultrasonographically visualized enlarged nodes. A combined method using radioisotope and blue dye was used for SLN biopsy. The procedure was omitted in patients (N=14, 16.3%) with FNAC suggesting AN metastases, and thus they underwent level I-II axillary dissection, as well as those (8 out of 72, 11.1%) with positive SLN biopsy on frozen section. Results: Final pathology showed 4 pT1bN0, 1 pT1bN1, 60 pT1cN0, and 21 pT1cN1 BC. AN metastases was confirmed in all patients with positive FNAC. The sensitivity, specificity, and accuracy were 59.1%, 93.7%, and 84.9% for SSM, 63.6%, 90.6%, and 83.7% for US, and 72.7%, 97.8%, and 90.7% for SSM and US together. However, the results did not differ significantly (p=NS, chi-squared test). Conclusions: In patients with BC, preoperatively selected by SSM and US, in whom US-guided axillary FNAC has shown the presence of AN metastases, the SLN biopsy can be avoided, and AN dissection should be the primary procedure.
2007
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2501844
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