Background Screening: The Visual Truth About Background Screening
Background
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Transcript of Background
Background
• Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status
• Therefore, axillary node dissection could be avoided in the majority of women with breast cancer
Purpose of the study
• To evaluate in a prospective manner the value of sentinel lymph node biopsy (SLND) in the management of patients with breast cancer
• To evaluate if the technique can be applied safely and proficiently in a Cancer Unit of a Community Hospital in Rome, Italy
Methods• All patients were entered onto a prospective
data base• All patients signed an informed consent• Patients were injected with Tecnectium-99
around the breast tumor area and/or Patent Blu dye to identify the SLND
• The biopsy was directioned by a hand-held gamma probe in the operating room (Scintiprobe MR100 - Pol.hi.tech, ITALY)
Methods
• The first 15 patients underwent routine axillary node dissection to validate the technique
• Thereafter, only patients with positive SLND, suspicious findings, or personal preference underwent partial or total axillary node dissection
Patients
• 68 consecutive patients from January 1999 to January 2000 with unicentric breast cancer less than 3 cm in diameter
• 67 women, 1 man• Median age 62 years (range 37-85)• 52 post-menopausal, 15 pre-menopausal• Median tumor diameter 1.5 cm (range 0.4-3
cm)
Technique
• Intradermal or subdermal injection of 0.6-1 mCi of Tc-99 filtered nanocolloid (6-20 hours before surgery)
• Lymphoscintigraphy• Intradermal injection of 1-3 cc of Patent Blue
at the biopsy site 5-10 minutes before the axillary biopsy
• Hand-held gamma probe in the OR
Tumor histology
0
10
20
30
40
50
60
InfiltratingDuctal
Mucinous Lobular DCIS
Type of Operation
• 17/68 patients (25%) underwent mastectomy at the time of SLND biopsy
• 4 additional patients (6%) underwent mastectomy after initial biopsy and SLND due to unfavorable characteristics of the primary tumor
• 45 patients (66%) underwent SLND biopsy synchronous to primary treatment of the breast tumor
Localization technique
0
10
20
30
40
50
60
Tc-99 & Blu Dye Blu Dye only Tc-99 only
Lymphoscintigraphy
MEDIAN RANGE
Dose Tc-99(mCi)
0.8 0.6-1.2
Number of SLNDvisualized/case
1 0-4
Time tovisualization (min)
20 5-105
Results
• A SLND was identified in in the OR in 64/68 cases (94%)
• 122 sentinel lymph nodes were identified in 64 patients (median = 2; range 1-4)
• 490 additional lymph nodes were removed in 68 patients (median 6 nodes/patient)
Sentinel Lymph NodeFindings in the operating room
01020
3040
5060
708090
100
HOT & BLU HOT ONLY BLU ONLY
PERCENT
Results
• Correlation between SLND and final lymph node status was in 62/64 patients (97%)
• In 11/20 positive cases the only metastatic lymph nodes were the sentinel nodes
• In these 11 patients 134 additional lymph nodes were removed and resulted negative
Results
• There were 20/68 patients (29%) with axillary metastasis (1-8 positive lymph nodes)
• 2/20 patients had only microscopic foci of cancer in the SLN’s, diagnosed after multiple H/E sections (n=1) or immunohistochemistry (n=1)
Results False negative Cases
• There were two false negative cases (3%)
• The first case in the series, likely due to technical error, was performed only with the Blue dye
• The 18th case, at SLND biopsy, multiple enlarged lymph nodes were encountered.
ResultsCorrelation between SLND and Positive axillary status (N=20)
17
21
0
2
4
6
8
10
12
14
16
18
TRUE POSITIVE FALSENEGATIVE
SLND NOTIDENTIFIED
Conclusions
• In this series, 42/68 patients (67%) with breast cancer could have spared unnecessary axillary lymph node dissection
• SLND can be performed safely and accurately in the community setting
• SLND is rapidly changing the breast cancer management paradigm