Validation of Subareolar and Periareolar Injection Techniques for Breast Sentinel Lymph Node Biopsy

Chagpar, Anees B.; Martin, Robert C.; Chao, Celia; Wong, Sandra L.; Edwards, Michael J.; Tuttle, Todd M.; McMasters, Kelly M.; Hansen, Nora M.; Silberman, Howard; Talpos, Gary B.; Bilchick, Anton Joel; McCarthy, Mary C.; Schmidt, Max; Goodnight, James E.

doi:10.1001/archsurg.139.6.614

Cited by 85 publications

(59 citation statements)

References 31 publications

(66 reference statements)

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“…The NEW START programme recommends the combined technique of radiocolloid and blue dye injection injected in a superficial plane for SLN localisation. This has been well validated, is easy to teach and use, is predictable, has rapid migration, high radiocolloid nodal uptake resulting in improved image quality and high SLN identification rates with comparable false negative rates to other techniques (8).…”

Section: Introductionmentioning

confidence: 99%

Sentinel node imaging in breast cancer using superficial injections: Technical details and observations

Somasundaram

Chicken

Waddington

et al. 2009

European Journal of Surgical Oncology (EJSO)

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Section: Introductionmentioning

confidence: 99%

Sentinel node imaging in breast cancer using superficial injections: Technical details and observations

Somasundaram

Chicken

Waddington

et al. 2009

European Journal of Surgical Oncology (EJSO)

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“…A large multi-centre clinical trial published by Chagpar et al [42] reported an identification rate of 91.1% for peritumoral injections, that contrasts with the 99.3% rate achieved when the patients in the same study underwent sub-areolar injections. Gross tumor involvement of the nodes may also impair the uptake of both the radiopharmaceutical (detected by imaging and/or the gamma probe) and by the blue dye resulting in failure in isolating the true SN [19].…”

Section: Discussionmentioning

confidence: 87%

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Camilleri¹,

Karen²,

Zarb³

2013

JCT

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Over the past two decades, the sentinel lymph node biopsy (SLNB) based on sentinel node (SN) being the first lymph node that harbors metastases, revolutionized breast cancer management. SLNB presents much less morbidity when compared to radical axillary lymph node dissection (ALND) where all nodes are dissected irrespective of their metastatic involvement. The purpose of this study was to evaluate the effectiveness of SLNB by investigating whether the histological characteristics of the SNs identified using scintigraphy are predictive of the histological characteristics of the ALN basin. Methods: Fifty-five female breast cancer patients underwent lymphoscintigraphy and SLNB followed by ALND. The histological status of the SN/s was correlated to the histological status of the ALNs to determine whether the SN accurately stages the ALNs in breast cancer. Results: During surgery, SNs were successfully isolated in 52 out of 55 cases (94.5%) (range, 0 to 9). No SNs were identified in 3 cases (5.5%). Results demonstrate a significant association (p = 0.05) between the metastatic status of SNs and the corresponding ALNs in 42 out of 52 patients (80.8%), but with a high false-negative rate (FNR) of 37.5%. Conclusion: The findings of this study show that the sentinel node concept provides the benefits of SLNB in the majority of instances. However, further work is required in reducing the FNR. Once the effectiveness of SLNB as a staging technique is locally established, the need of ALND in SN-negative patients would be limited, thus improving the quality of life of Maltese breast cancer patients.

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“…Despite refinements in injection techniques that have led to near 100% SLN identification in some studies, 1,4,5 variable FN rates have raised concern about the staging accuracy of this procedure. As with most diagnostic tests, SLN biopsy is not 100% sensitive: it does not infallibly detect nodal metastasis.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Factors Associated With False-Negative Sentinel Lymph-Node Biopsy in Breast Cancer

&NA;

2006

Annals of Surgery

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Summary Background Data:Previous studies have suggested a variety of factors that may affect the false negative (FN) rate for sentinel lymph node (SLN) biopsy in breast cancer. Because FN results are relatively rare, no prior studies have had sufficient sample size to allow detailed statistical analysis of factors predicting FN results. Methods: Patients with clinical stage T1-2, N0 invasive breast cancer were enrolled in a prospective, multicenter study. All patients underwent SLN biopsy, followed by planned completion axillary dissection regardless of the SLN results, to assess the FN rate. SLN biopsy was performed using radioactive colloid injection in combination with isosulfan blue dye in 94% of cases. Dermal, subdermal, peritumoral, or subareolar radioactive colloid injection techniques were used at the discretion of each institution. Univariate and multivariate analyses were performed to identify factors associated with a FN result. Results: SLNs were identified in 3870 of 4117 patients (94%). There were 1243 true positive, 2521 true negative, and 106 FN results. Age, histologic subtype, the number of non-SLN removed, tumor palpability, type of breast biopsy, and SLN injection technique were not significant factors. On multivariate analysis, tumor size Ͻ2.5 cm, upper outer quadrant tumor location, removal of only a single SLN, minimal surgeon experience, presence of a single positive axillary LN, and use of immunohistochemistry (IHC) for SLN analysis were independently associated with an increased risk of FN results. Conclusions:Surgeon experience, tumor size and location, and the number of SLN removed are preoperative and intraoperative factors that independently predict the risk of a FN result. In contrast to suggestions from other smaller studies, age does not affect the likelihood of a FN result; a lesser, rather than greater, number of positive axillary nodes was associated with an increased likelihood of a FN result; and IHC analysis of the SLN increases, rather than decreases, the risk of FN results. A lthough sentinel lymph node (SLN) biopsy has become widely accepted as an alternative to routine axillary dissection for breast cancer, the reported false negative (FN) rates have varied widely, from 0% to as high as 19%.1 A FN result could be detrimental to the patient because it results in inaccurate staging, with important implications for adjuvant therapy and the possibility of persistent axillary nodal disease. Previous studies have suggested a variety of factors that may affect the FN rate. However, because FN results are uncommon, no prior study has had a large enough sample size to systematically evaluate factors that are independently associated with FN results. Thus, the purpose of this analysis was to determine, in a large multi-institutional study, the factors that predict FN SLN biopsy results. METHODSThe University of Louisville Breast Cancer Sentinel Lymph Node Study is a prospective, multi-institutional study involving over 300 surgeons, mostly from community general surgery practices...

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Validation of Subareolar and Periareolar Injection Techniques for Breast Sentinel Lymph Node Biopsy

Cited by 85 publications

References 31 publications

Sentinel node imaging in breast cancer using superficial injections: Technical details and observations

Sentinel node imaging in breast cancer using superficial injections: Technical details and observations

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Clinicopathologic Factors Associated With False-Negative Sentinel Lymph-Node Biopsy in Breast Cancer

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