RESUMO
PURPOSE: The aim of this prospective study was to analyze the safety of methylene blue dye (MBD) and compare its efficacy with that of isotopic mapping for sentinel lymph node (SLN) identification in breast cancer. PATIENTS AND METHODS: The SLN procedure, involving isotopic mapping and MBD (subareolar intraparenchymal injections of 2 mL, 10 mg/mL), was performed on 100 patients with early breast cancer. RESULTS: The procedure was safe with a success rate of 99%; SLNs were, respectively, found in 65% by MBD, in 73% by lymphoscintigraphy and in 94% by gamma-probe. Out of 40 metastatic SLNs, 37 were "hot" and 32 stained. Digital examination allowed the detection of 2 additional metastatic LNs. CONCLUSION: MBD is safe and combination mapping associated with digital examination is the superior method. Modification of the procedure, favouring injections of dilute MBD (4 mL, 1.25 mg/mL) increases MBD efficiency (90%) and maintains low rates of complications.
Assuntos
Neoplasias da Mama/diagnóstico , Linfonodos/patologia , Azul de Metileno , Biópsia de Linfonodo Sentinela/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/diagnóstico por imagem , Carcinoma in Situ/patologia , Carcinoma in Situ/cirurgia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Enxofre , Coloide de Enxofre Marcado com Tecnécio Tc 99mRESUMO
BACKGROUND: Sentinel lymph node (SLN) procedure is now a widely accepted method of LN staging in selected invasive breast cancers (unifocal, size = 2 cm, clinically N0, without previous treatment). Complete axillary clearance is no longer needed if the SLN is negative. However, the oncological safety of this procedure remains to be addressed in randomized clinical trials. One main pitfall is the failure to visualize SLN, resulting in incorrect tumor staging, leading to suboptimal treatment or axillary recurrence. Operative gamma cameras have therefore been developed to optimize the SLN visualization and the quality control of surgery. CASE PRESENTATION: A 44-year-old female patient with a 14-mm infiltrative ductal carcinoma underwent the SLN procedure. An operative gamma camera was used during and after the surgery. The conventional lymphoscintigraphy showed only one SLN, which was also detected by the operative gamma camera, then removed and measured (9.6 kBq). It was analyzed by frozen sections, showing no cancer cells. During this analysis, the exploration of the axillary area with the operative gamma camera enabled the identification of a second SLN with low activity (0.5 kBq) that conventional lymphoscintigraphy, surgical probe and blue staining had failed to visualize. Histological examination revealed a macrometastasis. Axillary clearance was then performed, followed by a postoperative image proving that no SLN remained. Therefore, the use of the operative gamma camera prevented an under-estimation of staging which would have resulted in a suboptimal treatment for this patient. CONCLUSION: This case report illustrates that an efficient operative gamma camera may be able to decrease the risk of false negative rate of the SLN procedure, and could be an additional tool to control the quality of the surgery. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00357487.
RESUMO
UNLABELLED: The aim of this study was to evaluate the ability of a prototype intraoperative mini gamma-camera, the CarolIReS, with a 50 x 50 mm field of view, to precisely localize sentinel lymph nodes (SLNs) and to determine their depth in a series of patients with infiltrative breast cancer requiring SLN excision. METHODS: With the use of phantoms, the broadness of the signal of an acquired projection was shown to linearly depend on its distance from the collimator. A preclinical ex vivo study of 25 excised SLNs demonstrated that SLN size did not influence depth estimation. The minimum activity threshold for successful use of the proposed method was determined. After a preoperative radioisotope injection and lymphoscintigraphy, the SLN was localized in a series of 11 patients using both the mini gamma-camera and a gamma-probe. During surgery, a ruler was used to measure the depth of all SLNs before their excision. RESULTS: Using the measured linear dependence of image broadness, we found that the expected SLN anatomic depth was compatible with its measured depth during surgery. CONCLUSION: This study showed that the mini gamma-camera efficiently estimated the location of SLNs in 3 dimensions.