Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because...
-
Upload
abraham-wood -
Category
Documents
-
view
213 -
download
1
Transcript of Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because...
![Page 1: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/1.jpg)
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
![Page 2: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/2.jpg)
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
![Page 3: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/3.jpg)
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)
![Page 4: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/4.jpg)
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
![Page 5: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/5.jpg)
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)
![Page 6: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/6.jpg)
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
![Page 7: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/7.jpg)
Tumor histology
0
10
20
30
40
50
60
InfiltratingDuctal
Mucinous Lobular DCIS
![Page 8: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/8.jpg)
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
![Page 9: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/9.jpg)
Localization technique
0
10
20
30
40
50
60
Tc-99 & Blu Dye Blu Dye only Tc-99 only
![Page 10: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/10.jpg)
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
![Page 11: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/11.jpg)
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)
![Page 12: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/12.jpg)
Sentinel Lymph NodeFindings in the operating room
01020
3040
5060
708090
100
HOT & BLU HOT ONLY BLU ONLY
PERCENT
![Page 13: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/13.jpg)
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
![Page 14: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/14.jpg)
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)
![Page 15: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/15.jpg)
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.
![Page 16: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/16.jpg)
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
![Page 17: Background Sentinel lymph node biopsy has been recently introduced in the clinical setting because it is highly accurate in predicting the lymph node status.](https://reader036.fdocuments.us/reader036/viewer/2022083007/56649e385503460f94b2838c/html5/thumbnails/17.jpg)
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