With the patient already anaesthesiated, and at least five minutes before surgery, blue dye ( Bleu Patente V Sodique Guerbet ® 2.5%) was injected sub-areolarly in four deposits around the nipple totalling 2 ml. A skin mark was made over the first spot to become hot to facilitate SLN location during the operation. Planar scans of the involved breast and axillary area, in anterior and lateral projections, were acquired 15–30 minutes and 3 hours after tracer injection, to ascertain the overall distribution of the radiotracer and identify SLN. ![]() A total volume of 0.4 ml was injected sub-areolarly 15–24 hours before the operation. The 99mTc sulphur colloid was prepared by the nuclear medicine departments of two other validated institutions with which our hospital has an agreement ( Hospital CUF Descobertas and NuclearMed-Instituto de Medicina Nuclear), and comprised a solution containing 1.0mCi (1.0mCi = 37MBq) 99mTc labelled rhenium sulphide colloid (nanocolloid particles < 80 nm- Nanocis®). Using radiolabelled nanocolloid and patent blue vital dye as tracers, SLNB was performed in patients with breast cancer and its feasibility evaluated for patients in our institution.ĭuring study enrolment at our institution, the SLNB technique included the use of technetium-99m ( 99mTc) sulphur colloid and blue dye. The purpose of this study was to evaluate the accuracy of SLNB at this institution and to thereafter implement it as the standard method of staging in patients with early breast cancer. Many medical centres adopted SLNB without completion of ALND in patients who have a clinical negative SLN, in an effort to decrease the morbidity of axillary lymphoadenectomy while maintaining accurate staging. Results from international breast cancer centres show that, with the use of optimal techniques, SLNB predicts axillary nodal status with high accuracy and low clinical false-negative rates. Many studies have shown that SLNB accurately predicts axillary lymph node status and is associated with less morbidity than ALND completion. Over the past 14 years, sentinel node biopsy in breast cancer patients has become an exciting research topic. Since metastatic breast cancer cells travel via this route, an SLN free of metastatic cancer predicts the status of the remaining axillary nodes as also negative for metastasis. The sentinel lymph node (SLN) is the first lymph node to drain the entire lymphatics of the breast. The SLNB serves as a stand alone method for determining axillary nodal status, providing physicians with the ability to distinguish positive axillary lymph nodes in a relatively simple, safe, rational and accurate fashion. ![]() Īs about 60–70% of patients with early breast cancer have no regional axillary lymph node metastasis, sentinel lymph node biopsy (SLNB) is an easy to establish, ideal alternative, capable of accurately predicting the state of axillary lymph nodes, avoiding classical axillary lymph node staging and its consequent morbidity.Īfter being first described by Cabanas et al in 1977, for carcinoma of the penis, the SLNB technique was then used in staging malignant melanoma, as reported in 1992, by Morton et al, and more recently for breast carcinoma as reported by Krag et al in 1993 and Giuliano et al in 1994. ![]() However, for patients with pathologically negative lymph nodes survival rates are not increased by ALND, and there are a considerable number of related complications, such as sensory nerve damage, haemorrhaging, seroma formation (20–55% of cases) and chronic lymphoedema of the arm (7–56%). Axillary lymph node dissection (ALND) provides information about disease stage, local control of disease, and helps in the decision making for adjuvant therapy. ![]() It is important that effective screening methods and accurate ways for staging and prognosis once the diagnosis has been established are available. About one in 12 will develop the disease before the age of 75 years, representing a lifetime risk around 8%. Breast cancer is the most common malignancy among women in Europe, accounting for 20% or more of all cancers and representing the leading cause of cancer deaths in females between 35 and 55 years old in Europe.
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