Gallegos-Hernández JF, Aranda-Soto M, García R, Zarco-Espinosa G, Pichardo P, Melhado-Orellana OA

Language: Spanish
References: 22
Page: 339-345
PDF size: 94.26 Kb.

ABSTRACT

Introduction: Identification of the sentinel node (SN) allows appropriate staging of patients with breast cancer without the need of axillary radical dissection. Success in its detection depends mainly on technique used and injection sites of lymphography. Objective: Our objective were to describe radio-guided lymphadenectomy technique of SN, associating blue dye subareolar injection to radiocolloid, to perceive sensitivity of the procedure and index of success in identification of the first nodal relay in patients with invasive breast cancer without palpable axillary nodes, and to prove that SN is common for mammary skin and parenchyma. Material and methods: We described lymphatic mapping technique with radiocolloid and patent V blue dye in a series of 22 patients. Preoperative lymphography with 3mCi of intratumoral nanocolloid (Tc⁹⁹) was carried out, SN was identified, and supra-adjacent skin was marked; the day of the proceeding subareolar dye was injected, SN was identified by its blue color dye, and radioctivity was detected with Neoprobe 2000^TM. All patients were subjected to axillary radical dissection. Sensitivity, positive and negative predictive values, and rate of false negative were calculated. Results: The study comprised 22 patients; at least one axillary SN was identified in preoperative lymphogammagraphy of all patients; two (9%) also had one SN in internal mammary chain and showed supraclavicular drainage. Transoperatively, at least one SN was identified in all patients. Rate of false negative was 0, and 73% of patients did not show metastasis in SN and in other axillary nodes. Negative predictive value was 100%. SN radio-guided lymphadenectomy had a success rate of 100% without false negatives in this series. Lymphatic drainage of the mammary gland is through Sappey’s plexus toward one sentinel node, evidenced by finding the node dyed with blue and radioactive. Mapping carried out only with dye has a lower rate of success in identification of sentinel node and does not identify extra-axillary drainage sites; association of radiocolloid injected intratumorally and dye increases success rate and identifies sentinel nodes in extra-axillary sites.

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