Optimización de la biopsia selectiva de ganglio centinela en el cáncer de mama mediante palpación axilar intraoperatoria
- Justo Serrano Vicente
- José Rafael Infante de la Torre
- M. Luz Domínguez
- Lucía García Bernardo
- Carmen Durán Barquero
- Juan Ignacio Rayo Madrid
- Román Sánchez Sánchez
- María Isabel Correa Antúnez
- José Luis Amaya Lozano
- Antonio Félix Conde Martín
ISSN: 0212-6982
Year of publication: 2010
Volume: 29
Issue: 1
Pages: 8-11
Type: Article
More publications in: Revista española de medicina nuclear
Abstract
Introduction. Sentinel node biopsy (SNB) by radioisotopes is a widely accepted and reliable surgical method for staging breast cancer in patients with unknown positive axillary lymph nodes involvement. The main limitation of this method is due to the appearance of false negatives that may be caused by tumor lymph node blockage of the sentinel lymph node and uptake in the neighboring lymph nodes. Infiltered sentinel nodes are generally increased in size and firm. Thus, they can be detected by intraoperative palpation, even when there is no uptake by the radiotracer. Aim. To reduce the false negative rates by applying intraoperative axillary palpation after SNB. Method. Over a two-year period, we complemented the SNB in 168 patients with careful intraoperative axillary palpation, detecting and removing all the palpable suspicious lymph nodes (SLN) that were analyzed as sentinel nodes. Results. In 32 out of 168 patients, 50 palpable SLN were found. In 3 out of 32 patients, 4 infiltrated SLNs were demonstrated with negative SNB and positive axillary lymphadenectomy. Thus, intraoperative palpation avoided false negative results. In one patient, one palpable SLN with tumor involvement was observed and SNB was also positive. In the remaining 28 patients, the histological analysis of 45 SLN was negative for tumor but SNB was positive in 3 patients. Conclusion. Intraoperative axillary palpation, once the SNB was done, reduced the false negative rate. Thus, we consider that it should be included as one more part of this procedure.