SENTINEL LYMPH NODE BIOPSY: ONE YEAR EXPERIENCE

AT A COMMUNITY HOSPITAL IN ITALY.

Fortunato L, Benzoni C, Alessi G, Amini M, Manni C, Di Nardo A, Crenca F, Bianca S, Vitelli CE.  Department of Surgical Oncology,  Radiology,  Pathology,

MG Vannini Hospital, Rome – ITALY 00177

INTRODUCTION: Sentinel lymph node (SLN) biopsy is increasingly used as the preferred axillary staging procedure for women with early breast cancer. PATIENTS AND METHODS: 68 consecutive women receiving primary treatment of breast cancer less than 3 cm in diameter were prospectively studied from January    1999 to January 2000 . All patients signed a detailed informed consent. The majority of patients (85%) underwent a combined technique of intradermal injection of 0.6-1 mCi of Tc-99 filtered nanocolloid and 1-3 cc of Patent Blue dye at the biopsy site. Intraoperative localization was performed with a hand-held gamma probe (Scintiprobe MR100 – Pol.hi.tech, ITALY). Lymph nodes were analyzed by frozen section or touch-prep, and serially for H/E stain and IHC. The first 15 patients underwent routine back-up lymphadenectomy to validate the technique. Thereafter, only patients with positive SLN, suspicious findings, or personal preference underwent axillary dissection. RESULTS: The median age was 62 years (range 37-85). The median diameter of the breast tumor was 1,5 cm  (range 0.4-3 cm). Local anesthesia with sedation was used in 45% of cases. Success rate for identification of SLN was 94% (64/68 cases). One to 4 sentinel nodes were identified (median 2). The SLN was hot and blu in 68%, hot only in 22%, and blue only in 10% of cases. A total of 490 additional lymph nodes were removed after SLN biopsy (median 6 lymph nodes/patient; range 0-24). Correlation between SLN and the final axillary status was 97% (62/64  cases). The two false negative SLN were found in the first 18 cases. There were 20 patients with positive axillary nodes  (29%). In 11 of these, the only positive node was the sentinel lymph node. Two patients had only microscopic foci of cancer found on serial sectioning or IHC of the SLN.  Forty-two patients (67%) could have avoided axillary dissection becouse the SLN was found and it was truly negative. There were four minor complications.  CONCLUSIONS: SLN biopsy is safe, accurate and easily reproduced. The majority of breast cancer patients may no longer need routine axillary lymphadenectomy.