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2002, Number 2

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Cir Cir 2002; 70 (2)

How to do lymphatic mapping in breast cancer. Technique, indications, and controversies

Gallegos-Hernández JF, Melhado-Orellana A

Language: Spanish
References: 33
Page: 86-92
PDF size: 129.60 Kb.


ABSTRACT

Historically, axillary lymphadenectomy has played an important role in the prognosis and treatment of patients with breast cancer. Recently, its usefulness has been questioned because it does not improve either regional control or survival; nodal status is no longer needed to decide systemic treatment, and rate of complications is approximately 40%. Lymphatic mapping with sentinel node biopsy is a safe alternative for staging breast cancer patients, preventing classical lymphadenectomy. The aim of this article is to describe the subareolar technique for lymphatic mapping and to review the literature, which allows us to become acquainted with indications and controversial issues of this procedure. More than one half of patients in early stages of breast cancer and without axillary palpable nodes will be unnecessarily subjected to axillary dissection because they will not show nodal metastasis in the lymphadenectomy specimen. There is sufficient evidence that sentinel node (the first node that receives lymph flow) is a prognostic factor for axillary status, and lymphatic mapping is a safe staging procedure that prevents morbidity of axillary dissection. Although the best way of mapping the sentinel node is associating blue dye and nanocolloid subdermal (s.d.) injection of blue dye only identifies 92% of nodes, with false negative rate of 7.1. Some issues are controversial, such as the ideal manners of injection, lymphogammagraphy usefulness, and value of sentinel node in intraductal carcinoma and its impact in patient survival.


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