Results of sentinel node biopsy not affected by previous excisional biopsy
Introduction
Sentinel node (SN) biopsy is a widely adopted technique for nodal staging in breast cancer.1, 2, 3 As compared to axillary lymph node dissection (ALND), it provides similar staging information, with less morbidity. When performed by an experienced surgeon, sensitivity of SN biopsy is in excess of 95%.4, 5, 6, 7, 8, 9, 10 Therefore, a negative SN biopsy accurately predicts the absence of nodal tumour involvement in the axilla and justifies avoidance of complete ALND.
Controversy persists about the accuracy of SN biopsy following previous excisional biopsy. It is assumed that the lymphatic drainage pattern is altered in these patients, resulting in less accurate lymphatic mapping and unreliable results of the SN biopsy.3, 11 If this hypothesis is correct, then a number of breast cancer patients will be deprived of the advantages of the SN technique.
To date there are no published validation studies in which the reliability of the SN procedure in breast cancer patients following previous diagnostic excisional biopsy is investigated by performing a completion axillary lymph node dissection. For this study we reviewed the relevant data in our large prospective database on SN biopsy, to determine the accuracy of the procedure in this selected group of patients.
Section snippets
Patients and methods
We analysed all of our patients with stage T1—3 breast cancer, who had undergone diagnostic excisional biopsy prior to SN biopsy (group A). In this group 88 patients were operated in a period from April 1997 until January 2000 with approval of the local ethical committee and after obtaining informed consent. All group A patients underwent SN biopsy followed by a complete axillary lymph node dissection. All operative procedures were performed by two surgeons experienced in SN biopsies. In the
Results
In all, 88 consecutive patients with previous excisional biopsy (group A) were included in this study. Patient characteristics are listed in Table 1. Tumour size was pT1 in 58 patients, pT2 in 27 patients and pT3 in 3 patients. The average tumour size was 15 mm (range 3–70 mm). The primary tumour was located in the lateral quadrants in 55 patients, of which 26 tumours were in the upper-outer quadrant.
Lymphoscintigraphy visualized one or more axillary hot spots in 84/88 patients (Table 2). A
Discussion
Because of its high sensitivity and its minimally invasive nature, SN biopsy has replaced ALND as the primary procedure for axillary staging in breast cancer in many centers. However, various exclusion criteria have been formulated by different investigators. One of these exclusion criteria is a previous excisional biopsy.3, 6, 13 Prior surgery is assumed to alter the lymphatic drainage patterns by disrupting the lymphatic channels, thus preventing the surgeon from performing accurate lymphatic
Conclusion
Sentinel node biopsy for breast cancer following previous excisional biopsy is accurate for axillary lymph node staging, as is confirmed by completion axillary lymph node dissection in this study. Localisation of the biopsy, even in the upper outer quadrant, does not affect identification of the axillary sentinel node. Moreover, visualization and identification of internal mammary sentinel nodes is not impaired. Therefore, patients with previous excisional biopsy are eligible for the sentinel
References (19)
- et al.
Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer
Eur J Surg Oncol
(1997) - et al.
Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes
Lancet
(1997) - et al.
Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection
J Am Coll Surg
(1998) - et al.
Sentinel node localization in breast cancer
Semin Nucl Med
(1999) - et al.
Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer
Eur J Surg Oncol
(1999) - et al.
Reproducibility study of lymphoscintigraphy: excisional biopsy of breast lesions changes drainage patterns
Eur J Cancer
(2004) - et al.
Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy
J Am Coll Surg
(2001) - et al.
Axillary sentinel lymph nodes in breast cancer: a single lymphatic pathway drains the entire mammary gland
Eur J Surg Oncol
(2005) - et al.
Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe
Surg Oncol
(1993)
Cited by (43)
Evaluation of sentinel lymph node biopsy after previous breast surgery for breast cancer: GATA study
2016, BreastCitation Excerpt :The false negative rate was low (6.25%) like those described for SLN biopsy performed before breast surgery (5–10%) [8]. Our identification rate was less than those found in the literature [9–15] (Table 5). Above all, the quality of the perioperative SLN detection method is essential in order to obtain an acceptable identification rate.
Selective biopsy of the sentinel lymph node in patients with breast cancer and previous excisional biopsy: Is there a change in the reliability of the technique according to time from surgery?
2015, Revista Espanola de Medicina Nuclear e Imagen MolecularManagement of the axilla
2013, Hematology/Oncology Clinics of North AmericaCitation Excerpt :Many of the large clinical trials excluded patients who had previous breast biopsies or previous axillary surgery.43,44 Limited small studies suggest that identifying the SLN can be achieved after previous breast biopsies, regardless of the size, location, or the length of time between the initial biopsy and the SLNB procedure.45,46 Based on clinical experience, a prior breast biopsy is not considered a contraindication to SLNB.
Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer
2011, American Journal of SurgeryCitation Excerpt :Previous history of excisional biopsy is another factor that can influence the time of sentinel node visualization. Many studies reported comparable results regarding false-negative rate and detection rate in patients with excisional and core needle biopsy of the primary breast tumor.24–26 Haigh et al8 reported that the time interval between the biopsy and sentinel node mapping does not affect the accuracy of sentinel node biopsy.
Sentinel node biopsy in patients with breast cancer and previous breast surgery
2011, Revista Espanola de Medicina Nuclear