Significance of sentinel lymph node biopsy labeled by technetium Tc99m and patent blue in treatment of patients with the breast cancer

The major advance in breast cancer management is sentinel lymph node (SLN) localization and biopsy. The aim of the study was to assess the role of lymphatic mapping and gamma-probe guided lymph node biopsy in breast cancer patients. Thirteen women (mean age 49 years) were analyzed. Invasive ductal carcinoma was found in 62%, invasive lobular carcinoma in 15%, and ductal carcinoma in situ in 23%. A total of 0.3 ml (50 MBq) of human albumine labeled by technetium 99m was injected intradermally over the tumor. Dynamic lymphoscintigraphy was performed followed by early and late (16h) static scintigraphy. Blue dye (1%, 3 ml) was injected around the breast mass, 10 minutes before surgery. During the surgery, a gamma probe was used to localize SLN. All SLNs were examined by frozen section, hematoxylin eosin staining and immunohistochemically. The success rate of SLN identification was 100%. Six of the 13 patients (46%) had metastatic disease in the axilla. Of the 6 patients with metastases, the range of involved nodes was from 1 to 3. The SLN(s) was positive in all patients with metastatic disease (sensitivity: 100%), and thus there were no skip metastases (false negatives: 0%). The SLN was the only site of metastases in 4 of 6 patients (66%). Sentinel node biopsy is a highly accurate method for staging and treatment of breast cancer patients.