Montserrat Solà, Mireia Recaj, Eva Castellà, Pere Puig, Josep Maria Gubern, Juan Francisco Julian, Manel Fraile
{"title":"Sentinel Node Biopsy in Special Histologic Types of Invasive Breast Cancer.","authors":"Montserrat Solà, Mireia Recaj, Eva Castellà, Pere Puig, Josep Maria Gubern, Juan Francisco Julian, Manel Fraile","doi":"10.5152/tjbh.2016.2929","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility of sentinel node biopsy (SNB) in ductal and lobular invasive breast cancer, a group of tumors known as special histologic type (SHT) of breast cancer.</p><p><strong>Materials and methods: </strong>Between January 1997 and July 2008, 2253 patients from 6 affiliated hospitals underwent SNB who had early breast cancer and clinically negative axilla. The patients' data were collected in a multicenter database. For lymphatic mapping, all patients received an intralesional dose of radiocolloid Tc-99m (4mCi in 0.4 mL saline), at least two hours before the surgical procedure. SNB was performed by physicians from the same nuclear medicine department in all cases.</p><p><strong>Results: </strong>Of the 2253 patients in the database, the SN identification rate was 94.5% (no radiotracer migration in 123 patients), and positive sentinel node prevalence was 22%. SHT was reported in 144 patients (6.4%) of the whole series. In this subgroup, migration of radiotracer was unsuccessful in 8 patients (identification rate was 94.4%) and SNs were positive in 7.4%. SN positivity prevalence in these tumors was variable across the subtypes. Higher probability of lymphatic spread seemed to be related to tumor invasiveness (20% of positivity in micropapillary, 15% in cribriform subtypes, and 0% in adenoid-cystic).</p><p><strong>Conclusion: </strong>Sentinel node biopsy is feasible in special histologic subtypes of breast carcinoma with a good identification rate. Lower migration rates, however, might be associated with special histologic features (colloid subtype). Complete axillary dissection after a positive sentinel node cannot be omitted in patients with SHT breast cancer because they can be associated with further axillary disease; the reported very low incidence of axillary metastases would justify avoiding axillary dissection only in the adenoid-cystic subtype.</p>","PeriodicalId":91975,"journal":{"name":"The journal of breast health","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351505/pdf/jbh-12-2-78.pdf","citationCount":"7","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The journal of breast health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5152/tjbh.2016.2929","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 7
Abstract
Objective: To assess the feasibility of sentinel node biopsy (SNB) in ductal and lobular invasive breast cancer, a group of tumors known as special histologic type (SHT) of breast cancer.
Materials and methods: Between January 1997 and July 2008, 2253 patients from 6 affiliated hospitals underwent SNB who had early breast cancer and clinically negative axilla. The patients' data were collected in a multicenter database. For lymphatic mapping, all patients received an intralesional dose of radiocolloid Tc-99m (4mCi in 0.4 mL saline), at least two hours before the surgical procedure. SNB was performed by physicians from the same nuclear medicine department in all cases.
Results: Of the 2253 patients in the database, the SN identification rate was 94.5% (no radiotracer migration in 123 patients), and positive sentinel node prevalence was 22%. SHT was reported in 144 patients (6.4%) of the whole series. In this subgroup, migration of radiotracer was unsuccessful in 8 patients (identification rate was 94.4%) and SNs were positive in 7.4%. SN positivity prevalence in these tumors was variable across the subtypes. Higher probability of lymphatic spread seemed to be related to tumor invasiveness (20% of positivity in micropapillary, 15% in cribriform subtypes, and 0% in adenoid-cystic).
Conclusion: Sentinel node biopsy is feasible in special histologic subtypes of breast carcinoma with a good identification rate. Lower migration rates, however, might be associated with special histologic features (colloid subtype). Complete axillary dissection after a positive sentinel node cannot be omitted in patients with SHT breast cancer because they can be associated with further axillary disease; the reported very low incidence of axillary metastases would justify avoiding axillary dissection only in the adenoid-cystic subtype.