Biopsia de ganglio centinela en pacientes con cáncer de mama y cirugía mamaria previa / Sentinel node biopsy in patients with breast cancer and previous breast surgery

Objetivo. El objetivo de este estudio fue determinar la eficacia y seguridad de la biopsia del ganglio centinela para la estadificación linfática en pacientes con cáncer de mama y cirugía previa mamaria, considerando la extensión, localización y tiempo desde el procedimiento quirúrgico anterior. Material y métodos. Realizamos biopsia de ganglio centinela a 38 pacientes con cáncer de mama precoz y algún antecedente quirúrgico mamario: biopsia escisional reciente en 22 pacientes (grupo I), tumorectomía o mamoplastia antigua en 16 (grupo II), incluyendo una cirugía conservadora por cáncer de mama (recurrencia tumoral). Se realizó linfogammagrafía tras inyección periareolar y ocasionalmente también peri-cicatricial. Tras la exéresis del ganglio centinela se practicó linfadenectomía axilar solo cuando el ganglio fue positivo (o no localizado). Resultados. La eficacia de localización gammagráfica del ganglio centinela fue 92,1%, con 15,8% de drenajes extra-axilares; la tasa de detección quirúrgica axilar fue 81,6%. La identificación resultó similar tras biopsia escisional reciente y cirugía antigua (81,8 frente a 81,2%), con mayor porcentaje de ganglios extra-axilares en el segundo grupo (9,1% frente a 25%). La localización del antecedente quirúrgico en el cuadrante supero-externo produjo más drenajes extra-axilares (27,2% frente a 11,1%); la eficacia de detección axilar fue similar al resto de cuadrantes (81,8% frente a 81,5%). La tasa actual de eventos relacionados con la enfermedad es 5,2% (2/38), sin recurrencias locorregionales (seguimiento medio tres años). Conclusión. La biopsia del ganglio centinela tras cirugía mamaria no extensa puede realizarse con seguridad. Los drenajes extra-axilares son más frecuentes cuando el antecedente quirúrgico es amplio, remoto y en el cuadrante superoexterno(AU)

Aim. The aim of this study was to establish the efficacy and safety of sentinel lymph node biopsy for lymph node staging in patients with breast cancer and prior breast surgery, considering its extension, localization and time since the previous surgical procedure. Material and methods. A sentinel lymph node biopsy was performed in 38 patients with early breast cancer and previous breast surgery: recent excisional biopsy in 22 patients (Group I), previous lumpectomy or mammoplasty in 16, including one case of cancer treated with breast-conserving surgery (tumor recurrence). Lymphoscintigraphy was performed after periareolar injection, also sometimes adding an injection near to the surgical scar. After removing the sentinel node, axillary lymph node dissection was performed when the lymph node was positive (and not localized). Results. The efficacy of the scintigraphic localization of the sentinel node was 92.1% of the patients, with 15.8% of extra-axillary drainages. Axillary intraoperative detection was 81.6%. The identification rate after recent excisional biopsy or previous surgery was similar (81.8 vs 81.2%). However, extra-axillary sentinel nodes were more frequent in Group II (9.1 vs 25%). Having a localization of previous surgical procedures in upper outer quadrant caused drainages outside of the axilla more frequently (27.2 vs 11.1%). Axillary detection rate was similar to other quadrants (81.8 vs 81.5%). The rate of breast cancer-related events was 5.2% (2/38), without axillary recurrences (mean follow-up: 3 years). Conclusion. Sentinel lymph node biopsy in patients with previous but not extensive breast surgery is safe. Extra-axillary drainages are more common when the previous surgical area was wide, especially in the upper-outer quadrant(AU)

[Sentinel node biopsy in patients with breast cancer and previous breast surgery]. / Biopsia de ganglio centinela en pacientes con cáncer de mama y cirugía mamaria previa.

AIM: The aim of this study was to establish the efficacy and safety of sentinel lymph node biopsy for lymph node staging in patients with breast cancer and prior breast surgery, considering its extension, localization and time since the previous surgical procedure. MATERIAL AND METHODS: A sentinel lymph node biopsy was performed in 38 patients with early breast cancer and previous breast surgery: recent excisional biopsy in 22 patients (Group I), previous lumpectomy or mammoplasty in 16, including one case of cancer treated with breast-conserving surgery (tumor recurrence). Lymphoscintigraphy was performed after periareolar injection, also sometimes adding an injection near to the surgical scar. After removing the sentinel node, axillary lymph node dissection was performed when the lymph node was positive (and not localized). RESULTS: The efficacy of the scintigraphic localization of the sentinel node was 92.1% of the patients, with 15.8% of extra-axillary drainages. Axillary intraoperative detection was 81.6%. The identification rate after recent excisional biopsy or previous surgery was similar (81.8 vs 81.2%). However, extra-axillary sentinel nodes were more frequent in Group II (9.1 vs 25%). Having a localization of previous surgical procedures in upper outer quadrant caused drainages outside of the axilla more frequently (27.2 vs 11.1%). Axillary detection rate was similar to other quadrants (81.8 vs 81.5%). The rate of breast cancer-related events was 5.2% (2/38), without axillary recurrences (mean follow-up: 3 years). CONCLUSION: Sentinel lymph node biopsy in patients with previous but not extensive breast surgery is safe. Extra-axillary drainages are more common when the previous surgical area was wide, especially in the upper-outer quadrant.

[Sentinel node localization in breast cancer. Periareolar injection of radiocolloid]. / Localización del ganglio centinela en cáncer de mama. Inyección periareolar del radiocoloide.

Traditional lymphadenectomy is being replaced by sentinel node biopsy in initial management of early stage breast cancer. The aim of this study was to validate the technique in our center, where we perform preoperative lymphoscintigraphy and intraoperative detection of sentinel node, after periareolar radiotracer and peritumoral blue dye injection. Sixty patients, breast cancer stages I and II, were included. Lymphatic mapping was performed the day before surgery, after the administration of 74 MBq 99mTc sulfur colloid in periareolar subdermal tissue. Surgical detection of sentinel node through gamma probe was followed by intraoperative and occasionally delayed biopsies. Finally, full axillary node dissection was completed. Lymphoscintigraphy identified sentinel node in 78% of the patients (47/60): 43 in axilla, 4 in internal mammary chain. Probe guided axillary detection was achieved in 88% (53/60): in every patient with axillar migration in scan, in 9/13 without imaged drainage and in 1/4 with internal mammary chain migration. Sensitivity of blue dye technique was 75% (45/60), the concordance between both procedures being high. Considering both, the overall success rate of surgical detection was 90% (54/60); if we exclude those patients who showed exclusive extraaxillar drainage, the success rate reaches 95%. Malignancy was found in 24% of sentinel nodes removed (13/54); it being the only metastatic axillary node in 4/13. No false negative sentinel nodes were found. Therefore, negative predictive value and accuracy were 100%. These results allow us to validate the technique in our center.

Localización del ganglio centinela en cáncer de mama. Inyección periareolar del radiocoloide / Sentinel node localization in breast cancer. Periareolar injection of radiocolloid

La biopsia selectiva del ganglio centinela está progresivamente sustituyendo a la linfadenectomía tradicional en el manejo inicial de las pacientes con cáncer de mama en estadios precoces. El objetivo de este estudio ha sido validar la técnica en nuestro medio, en el que realizamos linfogammagrafía prequirúrgica y detección intraoperatoria del ganglio centinela, tras inyección periareolar del radiocoloide y peritumoral de "azul patente". Se incluyeron 60 pacientes con neoplasia mamaria, estadios I y II. Se realizó linfogammagrafía el día anterior a la intervención, administrando 74 MBq. de 99mTc-sulfuro coloidal en el tejido subdérmico periareolar. Tras la detección quirúrgica mediante gammasonda, se hizo biopsia intraoperatoria, y ocasionalmente diferida del GC. Por último, se completó el vaciamiento axilar. La linfogammagrafía fue positiva en el 78 por ciento de los pacientes (47/60): 43 en axila y 4 en mamaria interna. La detección axilar con sonda se consiguió en el 88 por ciento (53/60): en todos los de migración axilar gammagráfica, en 9/13 con gammagrafía previa negativa y en 1/4 con drenaje a mamaria. La sensibilidad del colorante fue del 75 por ciento (45/60), con alta concordancia entre ambas técnicas. Combinándolas, la eficacia de la detección quirúrgica axilar alcanzó el 90 por ciento (54/60); si excluimos los tres casos con drenaje único extraaxilar, la eficacia fue del 95 por ciento (54/57). EL GC fue maligno en el 24 por ciento de los casos (13/54), siendo en 4/13 el único metastásico del vaciamiento. No existieron falsos negativos, por lo que el VPN y la exactitud diagnóstica fueron del 100 por ciento. Concluimos que estos resultados nos permiten validar la técnica en nuestro medio (AU)

Síndrome de Bouveret. A propósito de un caso / A Bouveret syndrome. A case -report

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