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Safety of sentinel node biopsy in breast cancer patients who receive a second radioisotope injection after visualization failure in lymphoscintigraphy
Author(s) -
Meretoja Tuomo J.,
Joensuu Heikki,
Heikkilä Päivi S.,
Leidenius Marjut H.
Publication year - 2010
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21637
Subject(s) - medicine , axilla , sentinel node , breast cancer , axillary lymph node dissection , biopsy , surgery , radiology , sentinel lymph node , cancer
Background and Objectives A failure to visualize axillary sentinel nodes in lymphoscintigraphy may lead to an unsuccessful sentinel node biopsy (SNB) and subsequent axillary lymph node dissection (ALND). To avoid unnecessary ALND, a second radioisotope injection may be given but has been considered hazardous. We investigated the axillary recurrence rate after tumor‐negative SNB in breast cancer patients who received a second tracer injection after axillary visualization failure in lymphoscintigraphy. Methods Altogether 1,309 breast cancer patients who underwent a tumor‐negative SNB without an ALND were included. Two hundred seven (15.8%) patients received a second tracer injection due to visualization failure in lymphoscintigraphy and 1,102 (84.2%) did not. All patients received a blue dye injection prior to the SNB. The median follow‐up time was 43 months. Results No isolated cancer recurrences were diagnosed in the ipsilateral axilla among patients who received two radioisotope injections. Disease‐free survival and overall survival were similar among patients with one or two radioisotope injections ( P = 0.122 and P = 0.200, respectively). Conclusions Additional radiocolloid tracer injection after axillary non‐visualization in lymphoscintigraphy is safe and does not increase axillary recurrence risk after tumor‐negative SNB. The results suggest that such patients can be safely managed with SNB without a need to perform an ALND. J. Surg. Oncol. 2010;102:649–655. © 2010 Wiley‐Liss, Inc.