Lymphatic Mapping Techniques and Sentinel Lymph Node Biopsy in Breast Cancer

Abstract

The axillary nodal status is accepted universally as the most powerful prognostic tool available for early stage breast cancer. Breast cancer patients routinely undergo surgical staging of the axilla because other primary tumor features are inadequate in predicting the presence versus absence of nodal positivity [1][2][3]. The status of the axillary lymph nodes also guides treatment options and adjuvant therapies. The removal of level I and level II lymph nodes at axillary node dissection (ALND) is the most accurate method to assess nodal status, and it is the universal standard. ALND is associated with several adverse long-term sequelae including lymphedema, the disruption of nerves in the axilla, chronic shoulder pain, weakness, and joint dysfunction. Additionally, the survival advantage of ALND has been challenged, and less morbid methods of evaluating the axillary nodal basin have been sought.Breast cancer spreads from the tumor bed to one or a few lymph nodes before it spreads to other axillary nodes. These sentinel nodes can be identified and surgically excised for histological analysis. Lymphatic mapping with sentinel lymph node biopsy (SLNB) has emerged as an effective method of detecting axillary metastases. Veronesi and colleagues [4] randomly assigned 516 women with early stage breast cancer to either SLNB and ALND or SLNB alone (ALND was performed only for axillary metastases in the SLNB-alone arm). The authors demonstrated that SLNB was

The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 1—Overview, Detection, and Staging

“…For invasive disease, axillary nodal staging is routinely performed at the time of surgery. Approaches include targeted SLN dissection, guided by mapping techniques, and full axillary nodal dissection, guided by anatomic boundaries (18). Axillary sampling is performed largely for diagnostic purposes; the therapeutic value of lymph node removal remains largely unproven (19).…”

Tracer-cocktail injections for combined pre- and intraoperative multimodal imaging of lymph nodes in a spontaneous mouse prostate tumor model

“…21 However, the same study that states this FDA suggestion also revealed that a cocktail injection of ICG with 99m Tc-labeled sulfur radiocolloid reduced the fluorescence intensity by a factor of 10 and yielded poor imaging results. 22 Although 99m Tc-labeled sulfur colloid is the most widely used radioisotope for lymphatic mapping in the United States, in European countries 99m Tc-colloidal albumin ( 99m TcNanoColl) is more frequently used for identical procedures. 22,23 We have previously demonstrated in SLN imaging using a mouse model for metastatic breast cancer (one tumor draining lymph node) that the specificity of ICG99m Tc-NanoColl complexes is similar to conventional lymphoscintigraphy.…”

“…22 Although 99m Tc-labeled sulfur colloid is the most widely used radioisotope for lymphatic mapping in the United States, in European countries 99m Tc-colloidal albumin ( 99m TcNanoColl) is more frequently used for identical procedures. 22,23 We have previously demonstrated in SLN imaging using a mouse model for metastatic breast cancer (one tumor draining lymph node) that the specificity of ICG99m Tc-NanoColl complexes is similar to conventional lymphoscintigraphy. 24 Therefore, we reasoned that a cocktail injection of albumin (radiocolloids) and ICG could have potential.…”

Clinically Approved Nanoparticle Imaging Agents

“…Sulfur colloids are used in the imaging algorithm for the staging of breast cancer and, more recently, melanoma (5,6). After subcutaneous injection of less than 1 mL of 99m Tc-sulfur colloid nanoparticles near the breast tumor, they are able to enter the lymphatic system to delineate the drainage pathway of the tumor and hence identify the primary or sentinel lymph node (Fig.…”