LOS ANGELESA large German multicenter study has shown that sentinel lymph
node (SLN) biopsy for breast cancer accurately predicts the status of the
axillary lymph node. In addition, the study found that physician experience and
the choice of lymphography techniqueblue dye or scintigraphyinfluence the
detection rate significantly.
Speaking at the 49th Annual Meeting of the Society of Nuclear Medicine
(abstract 1170), Andreas Buck, MD, of the University of Ulm, Germany, reported
results from 814 breast cancer patients who underwent SLN biopsy and
consecutive axillary lymph node dissection.
The 80 surgeons involved in the study were free to choose their lymphography
technique. The blue dye technique was used in 137 patients, scintigraphy in 169
(see Figure), and combined blue dye/scintigraphy in 503. The results showed
that detection of the sentinel lymph node was highest when the blue dye and
scintigraphy techniques were combined (89.6%). Use of blue dye and scintigraphy
alone gave SLN detection rates of 71.6% and 78.8%, respectively.
In the scintigraphy technique, the combined subdermal/peritumoral injection
of the radiotracer produced a significantly higher SLN detection rate than
subdermal or peritumoral injection alone (96.8%, 84.6%, and 78.6%,
respectively; P < .001). Furthermore, there was a close relationship between
the number of sentinel lymph node procedures performed by a physician and the
The overall sensitivity for SLN biopsy in detecting lymph node metastases
was 91.3%. "Sentinel lymph node biopsy is a powerful tool to estimate the
axillary lymph node status with minimal invasiveness," Dr. Buck said.
"If the SLN tumor is negative, the whole axillary lymph node status can be
considered negative." He added that "it remains unclear how the
sensitivity of SLN biopsy can be increased and what rate of false-negative
findings is acceptable."
Not All Are Eligible
Dr. Andreas pointed out that not all breast cancer patients are eligible for
SLN scintigraphy. It is most appropriate in women with unifocal breast cancers
less than 3 cm, who have negative clinical examination by palpation and
ultrasound of the axilla, and who have not had previous surgery. The detection
rate of SLN scintigraphy is lower in patients who have had lumpectomies, he