Result of Sentinel Lymph Node Biopsy Using Radioisotope in Clinically Lymph Node Negative Breast Cancer

Hee Jeong Kim; Mi Ae Chang; Soo Jeong Hong; Jung Sun Lee; Min Sung Jung; Mee Jung Kim; Gyung Yub Gong; Euy Nyong Kim; Beom Seok Kwak; Sei Hyun Ahn; Byung Ho Son

doi:10.4048/jbc.2007.10.2.141

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Kim, Chang, Hong, Lee, Jung, Kim, Gong, Kim, Kwak, Ahn, and Son: Result of Sentinel Lymph Node Biopsy Using Radioisotope in Clinically Lymph Node Negative Breast Cancer

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2007; 10(2): 141-146.

Published online: 30 June 2007

DOI: https://doi.org/10.4048/jbc.2007.10.2.141

Result of Sentinel Lymph Node Biopsy Using Radioisotope in Clinically Lymph Node Negative Breast Cancer

Hee Jeong Kim, Mi Ae Chang, Soo Jeong Hong, Jung Sun Lee, Min Sung Jung, Mee Jung Kim¹, Gyung Yub Gong¹, Euy Nyong Kim², Beom Seok Kwak³, Sei Hyun Ahn, Byung Ho Son

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

¹Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Surgery, Dong-guk University International Hospital, Seoul, Korea.

brdrson@korea.com

Received 29 December 2006 Accepted 17 April 2007

Abstract

Purpose

Sentinel lymph node biopsy (SLNB) has been developed to accurately assess the axillary lymph node status accurately without having to remove most of the axillary contents in node negative early breast cancer patients. The aims of this study were to evaluate the accuracy, the false negative rate and the advantage of additional axillary sampling for SLNB with using radioisotope.

Methods

Between December 2003 and June 2005, we carried out SLNB for 574 breast cancer patients who were diagnosed and had operation at Asan Medical Center. For detection of the sentinel lymph node (SLN), radioisotope was injected into the periareolar area on the operating day, breast scintigraphy was performed and finally the biopsy was done using a gamma-detection probe in the operating room. If the SLN turned out to be positive for metastatic malignancy according to the frozen section histology, then additional axillary lymph nodes (LN) dissection was performed. But, if it was free of metastasis, then only axillary node sampling (n≤5) or no further treatment was done.

Results

The mean number of resected SLNs was 2.67±0.98 (1-7) and the mean number of total LN was 8.5±5.0 (1-38). The SLN was detected 82.8% of the time on lymphoscintigraphy and 98.4% of the time with the gamma probe. Axillary metastasis was founded in 118 cases (20.9%). The accuracy was 98.2%, and the false negative rate was 7.89%. For the SLN positive cases, there were 73/78 cases (93.6%) of 1st SLN metastasis, there were 75/78 cases (93.6%) of 1st and 2nd SLN metastasis, and 75/78 (93.6%) of 1st to 3rd SLN metastasis. The false negative rate of the alternative frozen section was 40% and that of the full frozen section was 24.1%. The difference was statistically significant.

Conclusion

SLNB using ^99mTc-antimony trisulfide colloid (0.5 mCi) showed a high detection rate and a low false negative rate. The false negative rate was decreased by using full section H&E staining and at least 3 SLNs showed the exact LN status. Even if the SLN was free of metastasis, additional sampling may decrease the false negative rate.

Keywords: Sentinel lymph node, Early breast cancer, False negative rate

Figures and Tables

Table 1

Clinicopathologic characteristics of patients

OP=operation; LN=lymph node; BCS=breast conserving surgery;SNB=sentinel node biopsy; ALND=axillary lymph node dissection.

Table 2

Average number of lymph node

SLN=sentinel lymph node.

Table 3

Results of lymphatic mapping

SLN=sentinel lymph node.

Table 4

Tumor status of axillary lymph node (permanent biopsy)

NSLN=non-sentinel lymph node; SLN=sentinel lymph node.

Table 5

Comparison of false negative rate according to frozen section method

H&E=Hematoxylin and Eosin stain; IHC=immunohistochemical stain.

Table 6

Identification of SLN metastasis on frozen section

SLN=sentinel lymph node; FS=frozen section.

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