Impact of previous surgery on sentinel lymph node mapping: Hybrid SPECT/CT before and after a unilateral diagnostic breast excision

• Published in: Breast (Edinburgh) 2016-12, Vol.30, p.32-38
• Main Authors: Zetterlund, Linda, Gabrielson, Stefan, Axelsson, Rimma, de Boniface, Jana, Frisell, Jan, Olsson, Annie, Celebioglu, Fuat
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Axilla; Biopsy - statistics & numerical data; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma, Intraductal, Noninfiltrating - pathology; Carcinoma, Intraductal, Noninfiltrating - surgery; Dilatation, Pathologic - pathology; Dilatation, Pathologic - surgery; Excisional biopsy; Female; Fibroadenoma - pathology; Fibroadenoma - surgery; Fibrocystic Breast Disease - pathology; Fibrocystic Breast Disease - surgery; Hematology, Oncology and Palliative Medicine; Humans; Hyperplasia; Lymphoscintigraphy; Mammary Glands, Human - pathology; Mammary Glands, Human - surgery; Mastectomy, Segmental - statistics & numerical data; Medicin och hälsovetenskap; Middle Aged; Papilloma - pathology; Papilloma - surgery; Prospective Studies; Radiopharmaceuticals; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel lymph node biopsy; Sentinel Lymph Node Biopsy - methods; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Aggregated Albumin; Young Adult
• ISSN: 0960-9776; 1532-3080; 1532-3080
• DOI: 10.1016/j.breast.2016.08.006

Abstract Background Earlier studies have shown conflicting results regarding the accuracy of sentinel lymph node biopsy after previous breast surgery, especially after a surgical biopsy. Purpose To compare lymph drainage patterns before and after a diagnostic unilateral surgical biopsy using the exact anatomical localisation of sentinel lymph nodes defined by SPECT/CT. Material and methods Thirty-seven women planned for unilateral surgical excision of an unsuspicious breast lesion were prospectively examined between September 2011 and January 2015. Hybrid SPECT/CT lymphoscintigraphy of the thorax and neck region with bilateral subareolar injections of99m Tc-Nanocoll was performed one week before and six weeks after surgery. The non-operated side served as a control. The primary outcome measure was the concordance between pre- and postoperative number and localisation of sentinel lymph nodes. Results Sentinel lymph node detection rate with SPECT/CT on operated sides was 91.9 per cent (34 of 37 procedures), to be compared with a detection rate of 93.7 per cent on all non-operated sides (104 of 111 procedures, P = 0.771). Partial or total concordance regarding the localisation and number of sentinel lymph nodes was 85.7 per cent (30 out of 35) on operated and 88.9 per cent (32 out of 36 patients) on non-operated breast sides (P = 0.735). Conclusion Breast surgery slightly decreased the concordance between pre- and postoperative sentinel lymph nodes, but this finding was not statistically significant. Our results thus support that it is feasible to perform a sentinel lymph node biopsy after previous breast excisional surgery with an acceptable level of safety.