Safety of sentinel node biopsy in breast cancer patients who receive a second radioisotope injection after visualization failure in lymphoscintigraphy

Meretoja, Tuomo J.; Joensuu, Heikki; Heikkilä, Päivi; Leidenius, Marjut

doi:10.1002/jso.21637

Cited by 7 publications

(6 citation statements)

References 33 publications

(66 reference statements)

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“…Therefore, additional single‐photon emission computed tomography (SPECT)/CT or a second radiotracer injection has been used to improve the SLN visualization and identification rate . A second radiotracer injection after nonvisualization on planar lymphoscintigraphy is safe and does not increase recurrence risk after tumor‐negative SLNB . In patients with persistent nonvisualization after SPECT/CT or radiotracer reinjection, exploration of the axilla with the help of palpation and blue dye in addition to the gamma probe improves the axillary SLN identification rate .…”

Section: Introductionmentioning

confidence: 99%

“…16 A second radiotracer injection after nonvisualization on planar lymphoscintigraphy is safe and does not increase recurrence risk after tumor-negative SLNB. 17 In patients with persistent nonvisualization after SPECT/CT or radiotracer reinjection, exploration of the axilla with the help of palpation and blue dye in addition to the gamma probe improves the axillary SLN identification rate. 18 Still, the accuracy of SLNB might be hampered in these patients.…”

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confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

mentioning

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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“…There are a variety of acceptable courses when lymphoscintigraphy fails to localize any SLNs. One successful approach used in the setting of breast surgery has been reported by Meretoja and colleagues [Meretoja et al, 2010]. 207 (15.8%) out of 1,309 patients undergoing lymphatic mapping were given a second injection of radiocolloid because of poor or no visualization of SLNs, and this was demonstrated to be an effective strategy for SLN identification with no apparent significant adverse effects.…”

Section: Complex Drainage Patters or Failure To Localize Sentinel Lymmentioning

confidence: 99%

Challenging Problems in the Surgical Management of Melanoma

Ganapathi¹,

Tyler²,

Mosca³

2011

Current Management of Malignant Melanoma

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“…A method to decrease the lymphatic mapping success rate in breast cancer patients is reinjection of the radiotracer in case of sentinel node mapping nonvisualization on lymphoscintigraphy [17][18][19][20][21][22]. However, reinjection of the radiotracer has not been evaluated enough in the literature.…”

Section: Introductionmentioning

confidence: 99%

Repeat injection following sentinel node nonvisualization on lymphoscintigraphy images can decrease axillary dissection rate in breast cancer patients

Aghaee

Soltani²,

Jangjoo

et al. 2021

Nuclear Medicine Communications

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Aim Sentinel node biopsy is considered the standard of care in early-stage breast cancer patients. In the current study, we evaluated the effect of radiotracer reinjection in the case of sentinel node nonvisualization on preoperative lymphoscintigraphy. Materials and methods Between March 2017 and March 2020, 1850 early-stage breast cancer patients were referred for sentinel node mapping. All patients received a single injected activity of Tc-99m Phytate intradermally in the periareolar area of the index lesion using an insulin syringe. Lymphoscintigraphy images of the patients were done 1–2 h postinjection. Between March 2017 and September 2017, sentinel node nonvisualization was reported to the surgeon, and for the rest of the study period, the patients received another injected activity of the radiotracer, and immediately, other lymphoscintigraphy images were taken (with the same parameters). Results A total of 255 patients entered our study. Fifty-five patients were in group I without any reinjection. The remainder of the patients were in group II. In 155 out of 200 patients of group II, a sentinel node could be visualized following reinjection of the radiotracer. The detection rate was 15 out of 45 and 15 out of 55 in group I and patients without sentinel node visualization even after reinjection, respectively. Axilla was involved in 5 out of 40 (12.5%) patients in group I with intraoperative sentinel node mapping failure. On the other hand, axilla was involved in 27 out of 30 (90%) group II patients with sentinel node nonvisualization. Conclusion Reinjection of the tracer in cases of no sentinel node visualization in lymphoscintigraphy for breast cancer increases the detection rate of sentinel nodes, and therefore a high number of unnecessary axillary lymph node dissections can be avoided.

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Safety of sentinel node biopsy in breast cancer patients who receive a second radioisotope injection after visualization failure in lymphoscintigraphy

Abstract: 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.

Cited by 7 publications

References 33 publications

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

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

Challenging Problems in the Surgical Management of Melanoma

Repeat injection following sentinel node nonvisualization on lymphoscintigraphy images can decrease axillary dissection rate in breast cancer patients

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