The Efficacy of Sentinel Lymph Node Biopsy Using Radioisotopes in Breast Cancer Patients

Youn, Hyun Jo; Jung, Sung Hoo

Abstract

PURPOSE: Sentinel lymph node biopsy (SLNB) is a minimally invasive procedure to avoid axillary dissection in breast cancer patients without axillary lymph node involvement, although there is no standardization of the technique. The aims of this study were to evaluate the efficacy of SLNB using radioisotopes in predicting axillary lymph node status, and to asses the clinical indications of SLNB.
METHODS
We conducted a prospective study of SLNB performed at Chonbuk National University Hospital between February 2000 and August 2005. All patients underwent SLNB, followed by planned completion axillary dissection regardless of the SLNB results. For identification of SLN, a radioisotope was used as a tracer with a peritumoral or subareolar injection, and SLNB using a gamma probe was performed after preoperative lymphoscintigraphy.
RESULTS
The sentinel lymph nodes were identified in 68 of the 70 patients (97.1%), with a mean of 2.84 sentinel nodes per patient. Overall, sensitivity was 83.3% (30/36), specificity 100% (32/32), accuracy 91.2% (62/68), and negative predictive value 84.2% (32/38). The false negative rate was 16.7% (6/36), and there was a significant difference in preoperative radiologic findings for axillary lymph node status (P=0.005).
CONCLUSION
Compared with peritumoral injection, SLNB using a subareolar injection of a radioisotope was an accurate alternative to complete axillary dissection. SLNB may be indicated when there is no evidence of axillary lymph node metastasis in the preoperative radiologic examination.