Skip to main content

Advertisement

SpringerLink
Log in

Unfiltered Sulfur Colloid and Sentinel Node Biopsy for Breast Cancer: Technical and Kinetic Considerations

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: There are few clinical data on technical limitations and radiocolloid kinetics related to sentinel lymph node (SLN) biopsy for breast cancer.

Methods: In 70 clinical node-negative patients, unfiltered99mTc sulfur-colloid was injected peritumorally and cutaneous hot spots were mapped with a gamma probe. SLN biopsy was performed followed by axillary lymph node dissection. Missed radioactive nodes (nodes not under hot spots) were removed from axillary lymph node dissection specimens and submitted separately.

Results: At least one hot spot was mapped in 69 patients (98%) and SLNs were retrieved in 62 (89%). No radiolabeled nodes were found in five (7%) and only nodes not under hot spots were retrieved in three patients (4%). Residual nodes not under hot spots were retrieved in 17 patients (24%) in whom at least one SLN specimen had been found. Diffuse radioactivity around the radiocolloid injection site impeded identification of all radiolabeled nodes during SLN biopsy, and was responsible for one of two false negatives (20 node-positive patients; false-negative rate 10%). Hot spot radioactivity, number of radiolabeled nodes, and nodal radioactivity did not change with time interval from radiocolloid injection to surgery (0.75–6.25 hours).

Conclusions: Although SLN localization rate is high, intraparenchymal injection may predispose to failure of radiocolloid migration, failure to identify SLNs because of high radiation background, and false-negative outcomes. Alternative routes of radiocolloid administration should be explored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel node in breast cancer using a gamma probe. Surg Oncol 1993;2:335–340.

    Article  CAS  PubMed  Google Scholar 

  2. Krag DN, Ashikaga T, Harlow SP, et al. Development of sentinel node targeting technique in breast cancer patients. Breast J 1998;4:67–74.

    Google Scholar 

  3. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391–401.

    PubMed  Google Scholar 

  4. Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995;222:394–401.

    Google Scholar 

  5. Giuliano AE, Barth AM, Spivack B, Beitsch PD, Evans SW. Incidence and predictors of axillary metastasis in T1 carcinoma of the breast. J Am Coll Surg 1996;183:185–189.

    CAS  PubMed  Google Scholar 

  6. Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in patients with breast cancer. JAMA 1996;276:1818–1822.

    Article  CAS  PubMed  Google Scholar 

  7. Pijpers R, Meijer S, Hoekstra OS, et al. Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer. J Nucl Med 1997;38:366–368.

    Google Scholar 

  8. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. Lancet 1997;349:1864–1867.

    Article  CAS  PubMed  Google Scholar 

  9. Borgstein PJ, Meijer S, Pijpers R. Intradermal blue dye to identify sentinel lymph node in breast cancer. Lancet 1997;349:1668–1669.

    CAS  Google Scholar 

  10. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345–2350.

    Google Scholar 

  11. Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998;227:645–653.

    Article  CAS  PubMed  Google Scholar 

  12. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer: A multicenter validation study. N Engl J Med 1998;339:941–946.

    Article  CAS  PubMed  Google Scholar 

  13. Gulec SA, Moffat FL, Carroll RG, et al. Sentinel lymph node localization in early breast cancer. J Nucl Med 1998;39:1388–1393.

    Google Scholar 

  14. Gulec SA, Moffat FL, Carroll RG. The expanding clinical role of intraoperative gamma probes. In: Freeman LM, ed. Nuclear medicine annual, 1997. Philadelphia: Lippincott-Raven, 1997:209–237.

    Google Scholar 

  15. Krag DN. Minimal access surgery for staging regional lymph nodes: The sentinel node concept. Curr Probl Surg 1998;35:951–1018.

    Google Scholar 

  16. Gulec SA, Moffat FL, Carroll RG, Krag DN. Gamma probe-guided sentinel node biopsy in breast cancer. Q J Nucl Med 1997;41:251–261.

    Google Scholar 

  17. Senofsky GM, Moffat FL, Davis K, et al. Total axillary lymphadenectomy in the management of breast cancer. Arch Surg 1991;126:1336–1342.

    Google Scholar 

  18. Moffat FL, Senofsky GM, Clark KC, Davis K, Robinson DS, Ketcham AS. Axillary node dissection for early breast cancer. Some is good, but all is better. J Surg Oncol 1992;51:8–13.

    Google Scholar 

  19. Temple WJ, Ketcham AS. Preservation of the intercostobrachial nerve during axillary dissection for breast cancer. Am J Surg 1985;150:585–588.

    Google Scholar 

  20. Aitken RJ, Gaze MN, Rodger A, Chetty U, Forrest APM. Arm morbidity within a trial of mastectomy and either nodal sample with selective radiotherapy or axillary clearance. Br J Surg 1989;76:568–571.

    Google Scholar 

  21. Jansen RFM, van Geel AN, de Groot HGW, Rottier AB, Olthuis GAA, van Putten WLJ. Immediate versus delayed shoulder exercises after axillary lymph node dissection. Am J Surg 1990;160:481–484.

    Google Scholar 

  22. Hladiuk M, Huchcroft S, Temple WJ, Schnurr BE. Arm function after axillary dissection for breast cancer: A pilot study to provide parameter estimates. J Surg Oncol 1992;50:47–52.

    CAS  PubMed  Google Scholar 

  23. Maunsell E, Brisson J, Deschênes L. Arm problems and psychological distress after surgery for breast cancer. Can J Surg 1993;36:315–320.

    Google Scholar 

  24. Hack TF, Cohen L, Katz J, Robson LS, Goss P. Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 1998;17:143–149.

    Google Scholar 

  25. Valagussa P, Bonadonna G, Veronesi U. Patterns of relapse and survival following radical mastectomy. Cancer 1978;41:1170–1178.

    Google Scholar 

  26. Morrow M, Foster RS Jr. Staging of breast cancer: A new rationale for internal mammary node biopsy. Arch Surg 1981;116:748–751.

    Google Scholar 

  27. McMasters KM, Giuliano AE, Ross MI, et al. Sentinel lymph node biopsy for breast cancer—not yet the standard of care. N Engl J Med 1998;339:990–995.

    Article  CAS  PubMed  Google Scholar 

  28. Miner TJ, Shriver CD, Jaques DP, Minascalco-Theberge ME, Krag DN. Ultrasonographically guided injection improves localization of the radiolabeled sentinel lymph node in breast cancer. Ann Surg Oncol 1998;5:315–321.

    Google Scholar 

  29. Linehan DC, Hill ADK, Tran KN, et al. Sentinel lymph node biopsy in breast cancer: unfiltered radioisotope is superior to filtered. J Amer Coll Surg 1999;188:377–381.

    Google Scholar 

  30. Snider H, Dowlatshahi K, Fan M, Bridger WM, Rayudu G, Oleske D. Sentinel node biopsy in the staging of breast cancer. Am J Surg 1998;176:305–310.

    Google Scholar 

  31. Barnwell JM, Arredondo MA, Kollmorgen D, et al. Sentinel node biopsy in breast cancer. Ann Surg Oncol 1998;5:126–130.

    Google Scholar 

  32. Nwariaku FE, Euhus DM, Beitsch PD, et al. Sentinel lymph node biopsy, an alternative to elective axillary dissection for breast cancer. Am J Surg 1998;176:529–531.

    Google Scholar 

  33. Rubio IT, Korourian S, Cowan C, Krag DN, Colvert M, Klimberg VS. Sentinel lymph node biopsy for staging breast cancer. Am J Surg 1998;176:532–537.

    Google Scholar 

  34. Strand SE, Persson BRR. Quantitative lymphoscintigraphy: Basic concepts for optimal uptake of radiocolloids in the parasternal lymph nodes of rabbits. J Nucl Med 1979;20:1038–1046.

    Google Scholar 

  35. Foster RS Jr. The biologic and clinical significance of lymphatic metastases in breast cancer. Surg Oncol Clin N Am 1996;5:79–104.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Surgical Oncology (310T), Room 3550, 1475 NW 12th Ave, Miami, FL, 33136

    Frederick L. Moffat Jr MD, Jodeen E. Boggs MD, Dido Franceschi MD, Christopher S. Pruett MD, Raoul Pop BS, Cem Gurkok BS & Alan S. Livingstone MD

  2. Division of Nuclear Medicine, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Surgical Oncology (310T), Room 3550, 1475 NW 12th Ave, Miami, FL, 33136

    Seza A. Gulec MD, Aldo N. Serafini MD & George N. Sfakianakis MD

  3. Department of Pathology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Surgical Oncology (310T), Room 3550, 1475 NW 12th Ave, Miami, FL, 33136

    Scott Y. Sittler MD

  4. Division of Surgical Oncology, Vermont Cancer Center, Burlington, VT

    David N. Krag MD

  5. University of Vermont College of Medicine, Burlington, VT

    David N. Krag MD

Authors
  1. Frederick L. Moffat Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seza A. Gulec MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Y. Sittler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aldo N. Serafini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. George N. Sfakianakis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jodeen E. Boggs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dido Franceschi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christopher S. Pruett MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Raoul Pop BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cem Gurkok BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alan S. Livingstone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. David N. Krag MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederick L. Moffat Jr MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moffat, F.L., Gulec, S.A., Sittler, S.Y. et al. Unfiltered Sulfur Colloid and Sentinel Node Biopsy for Breast Cancer: Technical and Kinetic Considerations. Ann Surg Oncol 6, 746–755 (1999). https://doi.org/10.1007/s10434-999-0746-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-999-0746-4

Key Word

Search

Navigation