Sentinel Node Biopsy and Concomitant Probe-Guided Tumor Excision of Nonpalpable Breast Cancer

Rijk, Maartje C. van; Tanis, Pieter J.; Nieweg, Omgo E.; Loo, Claudette E.; Olmos, Renato A. Valdés; Oldenburg, Hester S. A.; Rutgers, Emiel J.; Hoefnagel, Cornelis A.; Kroon, Bin B. R.

doi:10.1245/s10434-006-9070-4

Cited by 57 publications

(36 citation statements)

References 23 publications

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“…The radiotracer can serve for concomitant SNB (68,69). Van Rijk et al applied this combined procedure (also called SNOLL) to 368 patients after intratumoral injection of 99m Tc-nanocolloid.…”

Section: Snb and Concomitant Probe-guided Excision Of Nonpalpable Brementioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the factors influencing the false-negative rate of SNB in breast cancer; (2) the risks associated with the use of the technique in specific situations such as large tumors, multiple ipsilateral tumors, or the setting of neoadjuvant chemotherapy; and (3) the meaning of internal mammary drainage on lymphoscintigraphy in terms of risk of occult internal mammary involvement.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through March 2012.Axillary node status is a major prognostic factor in early breast cancer. Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (,5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting patients for whom internal mammary radiation has a high benefit-to-risk ratio.Key Words: sentinel node biopsy; breast cancer; micrometastases; lymphoscintigraphy; internal mammary node; radiation therapy; neoadjuvant chemotherapy Because imaging techniques have limited sensitivity, the axilla must be explored surgically. Traditional staging requires levels I and II axillary lymph node dissection (ALND) with 10 or more removed nodes (3). Axillary involvement is found in 10%-30% of patients with T1 (#2 cm) tumors, depending on size. This rate reaches 45% for small T2 tumors (2.1-3 cm) and 55%-70% for larger tumors (2,4). However, routine ALND carries the risk of lymphedema, sensory disturbances, and chr...

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Section: Snb and Concomitant Probe-guided Excision Of Nonpalpable Brementioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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show abstract

“…For non-palpable lesions, surgeons were typically guided by a gamma-ray detection probe, after preoperative intra-lesional injection of 99m Tc-nanocolloid (Nanocoll; GE-Healthcare, Eindhoven, The Netherlands) administered under ultrasound guidance [27]. Wide local excisions in our hospital are performed according to the technique described by Aspegren et al [28]: the incision is typically radial, skin is removed only for cosmetic reasons, tumor resection is performed with an intended macroscopic margin of at least 1 cm, generally down to the fascia and reconstruction of the breast parenchyma is done by mobilization of breast tissue in order to minimize the cavity.…”

Section: Surgerymentioning

confidence: 99%

The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study

Pengel

Loo

Teertstra

et al. 2008

Breast Cancer Res Treat

109

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“…GE-Healthcare, Eindhoven, The Netherlands) administered under ultrasound guidance, and detected and removed intraoperatively, guided by a gamma-ray probe [40]. Results of MRI and other preoperative diagnostic imaging were available for review in the operating theatre.…”

Section: Surgerymentioning

confidence: 99%

A practical approach to manage additional lesions at preoperative breast MRI in patients eligible for breast conserving therapy: results

Elshof

Rutgers

Deurloo

et al. 2010

Breast Cancer Res Treat

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Sentinel Node Biopsy and Concomitant Probe-Guided Tumor Excision of Nonpalpable Breast Cancer

Cited by 57 publications

References 23 publications

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study

A practical approach to manage additional lesions at preoperative breast MRI in patients eligible for breast conserving therapy: results

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