Background: Axillary lymph node dissection is an established component of the surgical treatment of breast cancer, and is an important procedure in cancer staging; however, it is associated with unpleasant side effects, We have investigated a radioactive tracer-guided procedure that facilitates identification, removal, and pathologic examination of the sentinel lymph node (i,e,, the lymph node first receiving lymphatic fluid from the area of the breast containing the tumor) to predict the status of the axilla and to assess the safety of foregoing axillary dissection if the sentinel lymph node shows no involvement, Methods: We injected 5-10 MBq of Tc-99m-labeled colloidal particles of human albumin peritumorally in 376 consecutive patients with breast cancer who were enrolled at the European Institute of Oncology during the period from March 1996 through March 1998. The sentinel lymph node in each case was visualized by lymphoscintigraphy, and its general location was marked on the overlying skin. During breast surgery, the sentinel lymph node was identified for removal by monitoring the acoustic signal from a hand-held gamma ray-detecting probe. Total axillary dissection was then carried out. The pathologic status of the sentinel lymph node was compared with that of the whole axilla, Results: The sentinel lymph node was identified in 371 (98.7%) of the 376 patients and accurately predicted the state of the axilla in 359 (95.5%) of the patients, with 12 false-negative findings (6.7%; 95% confidence interval 3.5%-11.4%) among a total of 180 patients with positive axillary lymph nodes. Conclusions: Sentinel lymph node biopsy using a gamma ray-detecting probe allows staging of the axilla with high accuracy in patients with primary breast cancer, A randomized trial is necessary to determine whether axillary dissection may be avoided in those patients with an uninvolved sentinel lymph node.

Sentinel lymph node biopsy and axillary dissection in breast cancer: Results in a large series / U. Veronesi, G. Paganelli, G. Viale, V. Galimberti, A. Luini, S. Zurrida, C. Robertson, V. Sacchini, P. Veronesi, E. Orvieto, C. De Cicco, M. Intra, G. Tosi, D. Scarpa. - In: JOURNAL OF THE NATIONAL CANCER INSTITUTE. - ISSN 0027-8874. - 91:4(1999 Feb 17), pp. 368-373.

Sentinel lymph node biopsy and axillary dissection in breast cancer: Results in a large series

G. Viale;S. Zurrida;V. Sacchini;P. Veronesi;
1999

Abstract

Background: Axillary lymph node dissection is an established component of the surgical treatment of breast cancer, and is an important procedure in cancer staging; however, it is associated with unpleasant side effects, We have investigated a radioactive tracer-guided procedure that facilitates identification, removal, and pathologic examination of the sentinel lymph node (i,e,, the lymph node first receiving lymphatic fluid from the area of the breast containing the tumor) to predict the status of the axilla and to assess the safety of foregoing axillary dissection if the sentinel lymph node shows no involvement, Methods: We injected 5-10 MBq of Tc-99m-labeled colloidal particles of human albumin peritumorally in 376 consecutive patients with breast cancer who were enrolled at the European Institute of Oncology during the period from March 1996 through March 1998. The sentinel lymph node in each case was visualized by lymphoscintigraphy, and its general location was marked on the overlying skin. During breast surgery, the sentinel lymph node was identified for removal by monitoring the acoustic signal from a hand-held gamma ray-detecting probe. Total axillary dissection was then carried out. The pathologic status of the sentinel lymph node was compared with that of the whole axilla, Results: The sentinel lymph node was identified in 371 (98.7%) of the 376 patients and accurately predicted the state of the axilla in 359 (95.5%) of the patients, with 12 false-negative findings (6.7%; 95% confidence interval 3.5%-11.4%) among a total of 180 patients with positive axillary lymph nodes. Conclusions: Sentinel lymph node biopsy using a gamma ray-detecting probe allows staging of the axilla with high accuracy in patients with primary breast cancer, A randomized trial is necessary to determine whether axillary dissection may be avoided in those patients with an uninvolved sentinel lymph node.
Settore MED/18 - Chirurgia Generale
17-feb-1999
Article (author)
File in questo prodotto:
File Dimensione Formato  
sentinel node_axillary dissection.pdf

accesso aperto

Tipologia: Pre-print (manoscritto inviato all'editore)
Dimensione 2.77 MB
Formato Adobe PDF
2.77 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/208126
Citazioni
  • ???jsp.display-item.citation.pmc??? 79
  • Scopus 710
  • ???jsp.display-item.citation.isi??? 592
social impact