Breast cancer lymphoscintigraphy: Factors associated with sentinel lymph node non visualization

Vaz, Sofia; Silva, Â.; Sousa, Rita; Ferreira, Teresa; Esteves, Susana; Carvalho, Inês; Ratão, P.; Daniel, Amelia; Salgado, L.

doi:10.1016/j.remn.2015.03.010

Cited by 7 publications

(10 citation statements)

References 13 publications

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“…Whether tumor location is a risk factor for SLN nonvisualization [ 3 , 6 ] is still disputable. We and other studies could not find a significant effect of tumor location on SLN nonvisualization [ 2 , 4 , 5 , 7 ].…”

Section: Discussioncontrasting

confidence: 73%

Risk factors for nonvisualization of the sentinel lymph node on lymphoscintigraphy in breast cancer patients

et al. 2021

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Background Accurate sentinel lymph node (SLN) staging is essential for both prognosis and treatment in patients with breast cancer. However, the preoperative lymphoscintigraphy may fail to visualize the SLN in some patients. The purpose of this retrospective study was to identify risk factors associated with SLN nonvisualization on lymphoscintigraphy. For this single-center retrospective study, all data of lymphoscintigraphy of SLN procedures from March 2011 to April 2021 were collected and reviewed from the Amsterdam UMC database. Results A total of 1886 SLN procedures were included in this study. The SLN nonvisualization rate was 25.1% on lymphoscintigraphy at 4 h post-injection. The SLN nonvisualization rate decreased to 9.4% after reinjection. Multivariable analysis showed that age ≥ 70 years (P < 0.001; OR: 2.27; 95% CI: 1.46–3.53), BMI ≥ 30 kg/m2 (P = 0.031; OR: 1.48; 95% CI: 1.04–2.12) and nonpalpable tumors (P = 0.004; OR: 1.54; 95% CI: 1.15–2.07) were independent predictors of SLN nonvisualization. Tumor location, brand of radiopharmaceutical, injected dose and volume, experience of preparer and administrator were not associated with SLN nonvisualization. None of the patient, tumor or tracer characteristics were associated with SLN nonvisualization after radiotracer reinjection. Conclusions This study shows that risk factors for SLN nonvisualization in breast cancer patients during preoperative lymphoscintigraphy are age ≥ 70 years, BMI ≥ 30 kg/m2 and nonpalpable tumors. Our results support the notion that SLN lymphoscintigraphy is a very robust technique that does not depend on the experience of the preparer or administrator of the radiotracer.

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Section: Discussioncontrasting

confidence: 73%

Risk factors for nonvisualization of the sentinel lymph node on lymphoscintigraphy in breast cancer patients

et al. 2021

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“…We have shown that a higher age and higher BMI negatively influence SLN visualization on preoperative imaging, as is in accordance with other studies . Further, we have found that nonpalpable tumors are significantly associated with SLN non‐visualization.…”

Section: Discussionsupporting

confidence: 91%

“…Preoperative lymphoscintigraphy after radiotracer injection serves as a roadmap to facilitate the surgeon in sentinel lymph node (SLN) identification . Patient‐specific factors such as larger tumor size, higher body mass index (BMI), higher age, and previous breast surgery or irradiation can result in lower SLN visualization rates on lymphoscintigraphy. Some studies have even demonstrated that nonvisualization on lymphoscintigraphy is associated with tumor‐positive lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

Hellingman

Veen

Wan

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Preoperative lymphoscintigraphy does not always visualize a sentinel lymph node (SLN). The study aim was to investigate whether persistent nonvisualization after additional single‐photon emission computed tomography (SPECT)/CT or a second radiotracer injection in breast cancer patients is associated with nodal metastases or worse outcome due to potential understaging and consequently undertreatment. Methods Altogether 2042 consecutive SLN procedures were evaluated. All patients were clinically node‐negative, underwent axillary ultrasound and fine‐needle aspiration cytology (US/FNAC) of suspicious nodes. Lymphoscintigraphy was performed at 3 to 4 hours after intratumoral injection of 99mTc‐nanocolloid. SPECT/CT or a reinjection was performed when initial lymphoscintigraphy showed nonvisualization. Results Persistent nonvisualization was seen in 170 of 2042 procedures (8.3%). The nodal metastasis rate was 16.0% vs 18.0% for procedures with nonvisualization vs SLN visualization, respectively (P = 0.593). The regional recurrence rate of tumor‐negative SLN biopsy procedures was equal between the nonvisualization (0.7%, 11 of 1535) vs visualization (0.7%, 1 of 144) group. Median follow‐up was 48 months. Distant–metastasis free interval and overall survival was not significantly different between both groups ( P = 0.164 and 0.208, respectively). Conclusions Persistent nonvisualization after lymphoscintigraphy plus SPECT/CT or radiotracer reinjection is not associated with a higher nodal metastasis rate or worse long term outcome when preoperative US/FNAC is performed.

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“…Although two different studies reported in univariate analyses a signi cant correlation between tumor size > 20 mm and SLN nonvisualization lymphoscintigraphy in breast cancer patients, Hellingman et al showed in a multivariable model an equal correlation between tumor size and SLN nonvisualization(6,7,13). Despite this fact, we and the vast majority of other research groups were unable to nd any signi cant effect of tumor size on SLN nonvisualization(2)(3)(4)(5)(14)(15)(16)(17)(18)(19).…”

contrasting

confidence: 56%

“…However, preoperative lymphoscintigraphy may fail to visualize the SLN. In the literature, reported rates of SLN nonvisualization vary between 2 and 28% (2)(3)(4)(5)(6)(7). After investigation of a large dataset of breast cancer patients (n = 1462) we recently reported that age ≥ 70 years (P < 0.001; OR: 2.27; 95% CI: 1.46-3.53), body mass index (BMI) ≥ 30 kg/m 2 (P = 0.031; OR: 1.48; 95% CI: 1.04-2.12), and non-palpable tumors (P = 0.004; OR: 1.54; 95% CI: 1.15-2.07) were independent predictors of SLN nonvisualization on lymphoscintigraphy (8).…”

Section: Introductionmentioning

confidence: 99%

Anatomical Breast Imaging Derived Parameters Do Not Provide Incremental Information In Prediction of Nonvisualization of Sentinel Lymph Nodes On Lymphoscintigraphy

Chahid

Verberne

Poel

et al. 2022

Preprint

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Background: Accurate sentinel lymph node (SLN) staging is essential for both prognosis and treatment in patients with breast cancer. However, the preoperative lymphoscintigraphy may fail to visualize the SLN. The aim of this retrospective study was to investigate whether parameters derived from anatomical breast imaging can predict SLN nonvisualization on lymphoscintigraphy. For this single-center retrospective study all data of mammography, breast magnetic resonance imaging (MRI), and lymphoscintigraphy of SLN procedures from January 2016 to April 2021 were collected and reviewed from the Amsterdam UMC electronic health records database.Results: A total of 758 breast cancer patients were included in this study. The SLN nonvisualization rate was 29.7% on lymphoscintigraphy. Multivariable analysis showed that age ≥ 70 years (P = 0.019; OR: 1.82; 95% CI: 1.10–3.01), BMI ≥ 30 kg/m2 (P = 0.031; OR: 1.59; 95% CI: 1.04–2.43), and nonpalpable tumors (P = 0.034; OR: 1.54; 95% CI: 1.03–2.04) were independent predictors of SLN nonvisualization. Differences in tumor size, Breast Imaging-Reporting and Data System (BI-RADS) classification, or breast density were not significantly associated with SLN nonvisualization.Conclusions: This study shows that, by using a multivariable analysis, risk factors for SLN nonvisualization in breast cancer patients during preoperative lymphoscintigraphy are age ≥70 years, BMI ≥30 kg/m2, and nonpalpable tumors. Parameters derived from mammography or breast MRI, however, are not useful to predict SLN nonvisualization on lymphoscintigraphy.

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Breast cancer lymphoscintigraphy: Factors associated with sentinel lymph node non visualization

Cited by 7 publications

References 13 publications

Risk factors for nonvisualization of the sentinel lymph node on lymphoscintigraphy in breast cancer patients

Risk factors for nonvisualization of the sentinel lymph node on lymphoscintigraphy in breast cancer patients

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

Anatomical Breast Imaging Derived Parameters Do Not Provide Incremental Information In Prediction of Nonvisualization of Sentinel Lymph Nodes On Lymphoscintigraphy

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