Preoperative Axillary Ultrasound-guided Wire Localization and lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer Patients
-
Fezzeh Elyasinia
,
Homa Hemmasi
,
Karamollah Toolabi
,
Afsaneh Alikhassi
,
Mehran Sohrabi Maralani
,
Ehsan Sadeghian
Abstract
Introduction: Breast cancer is the highest incidence and mortality of female malignant tumors with negative axillary lymph nodes has been diagnosed mainly at an early stage. Sentinel lymph node biopsy (SLNB) is a standard screening technique for patients with early-stage breast cancer and clinically negative lymph nodes. Lymphoscintigraphy mapping was regularly used as the standard method for SLNB. Recently, ultrasound-guided wire localization (USGWL) is a well-established technique with superior outcomes. Therefore, we attempted to determine whether preoperative UGWL and lymphoscintigraphy (blue dye and isotope injection) improve SLN detection and false-negative rate in breast cancer patients undergoing SLNB and also identify clinical factors that may affect the diagnostic accuracy of axillary ultrasound. Patients and methods: Between December 2018 and June 2019, 55 patients with clinical T1-3N0 breast cancer who were eligible for an SLNB at Imam Khomeini Hospital in Tehran included in our study. Tumor characteristics and demographic information were collected from medical records, and prepared questionnaires by our surgical team. The day before SLNB, all patients underwent ultrasound-guided wire localization of SLN. Lymphoscintigraphy performed with an unfiltered 99mTc-labelled sulfur colloid peritumoral injection followed by methylene blue dye injection. The results were analyzed based on the permanent pathology report. Results: Among the 55 patients, (71.8%) SLNs were detected by wire localization, while (57.8%) SLNs were found by methylene blue mapping and (59.6%) by gamma probe detection. In comparison with wire localization and isotope injection, the methylene blue dye technique had low sensitivity of 72.2%, while both wire localization and isotope injection reached 77.8%. The sensitivity, specificity, and accuracy of UGWL were 77.8%, 42.1%, and 65.4%, respectively. Otherwise, the accuracy of methylene blue dye and isotope injection was 47.3% and 50.1%, respectively. Furthermore, there was a significant relationship between BMI, tumor size, laterality, reactive ALN, and the accuracy of preoperative AUS. But there was no significant correlation between age, weight, height, tumor biopsy, tumor location, the time interval between methylene blue dye and isotope injection to surgery, and also the type of surgery to the accuracy of preoperative AUS. Conclusion: Preoperative UGWL can effectively identify SLNs compared to lymphoscintigraphy (blue dye and isotope injection) in early breast cancer patients undergoing SLNB.
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10.Ganott MA, Zuley ML, Abrams GS, Lu AH, Kelly AE, Sumkin JH, et al. Ultrasound guided core biopsy versus fineneedle aspiration for evaluation of axillary lymphadenopathy in patients with breast cancer. International Scholarly Research Notices. 2014.
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12.Luparia A, Campanino P, Cotti R, Lucarelli D, Durando M, Mariscotti G, et al. Role of axillary ultrasound in thepreoperative diagnosis of lymph node metastases in patients affected by breast carcinoma. La radiologia medica.2010;115(2):225-37.
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14.Khare S, Singh T, Santosh I, Laroiya I, Singh G. Wire-andUltrasound-Guided Localization: A Novel Technique for Excision of Non-palpable Breast Tumors. Breast Cancer:Basic and Clinical Research. 2020;14:1178223420938068.
15.Mariani G, Villa G, Gipponi M, Bianchi P, Buffoni F, Agnese G, et al. Mapping sentinel lymph node in breast cancer by combined lymphoscintigraphy, blue-dye, and intraoperative gamma-probe. Cancer Biotherapy and Radiopharmaceuticals. 2000;15(3):245-52.
16.Shen J, Gilcrease MZ, Babiera GV, Ross MI, Meric‐Bernstam F, Feig BW, et al. Feasibility and accuracy of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients with documented axillary metastases. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2007;109(7):1255-63.
17.Mathelin C, Croce S, Brasse D, Gairard B, Gharbi M, Andriamisandratsoa N, et al. Methylene blue dye, an accurate dye for sentinel lymph node identification in early breast cancer. Anticancer research. 2009;29(10):4119-25.
18.Eldrageely K, Vargas MP, Khalkhali I, Venegas R. Sentinel lymph node mapping of breast cancer: a case-control studyof methylene blue tracer compared to isosulfan blue. The American Surgeon. 2004;70(10):872.
19.Olfatbakhsh A, Haghighat S, Sari F, Beheshtian T, Hashemi EA, Jafari M. The Accuracy of Preoperative Axillary Ultrasound in the Diagnosis of Lymph Node Involvement at Motamed Cancer Institute, Iran. International Journal of Cancer Management. 2020;13(4).
20.Specht MC, Fey JV, Borgen PI, Cody III HS. Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy? Journal of the American College of Surgeons. 2005;200(1):10-4.
21.Valente SA, Levine GM, Silverstein MJ, Rayhanabad JA, Weng-Grumley JG, Ji L, et al. Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Annals of surgical oncology. 2012;19(6):1825-30.
22.Chen X, Li X, Fan Z, Li J, Xie Y, Wang T, et al. Ultrasound as a replacement for physical examination in clinical stagingof axillary lymph nodes in breast cancer patients. Thoracic Cancer. 2020;11(1):48-54.
23.Goyal A, Newcombe RG, Chhabra A, Mansel RE. Factors affecting failed localisation and false-negative rates of sentinelnode biopsy in breast cancer–results of the ALMANACvalidation phase. Breast cancer research and treatment.2006;99(2):203-8.
24.Lumachi F, Norberto L, Zanella S, Marino F, Basso SM, BassoU, et al. Axillary node sampling in conjunction with sentinelnode biopsy in patients with breast cancer. A prospectivepreliminary study. Anticancer research. 2011;31(2):693-7.
25.Narui K, Ishikawa T, Kito A, Shimizu D, Chishima T, Momiyama N, et al. Observational study of blue dye-assisted four-node sampling for axillary staging in early breastcancer. European Journal of Surgical Oncology (EJSO).2010;36(8):731-6.
26.Wang Y, Dong H, Wu H, Zhang L, Yuan K, Chen H, et al. Improved false negative rate of axillary status using sentinellymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer. BMC cancer. 2015;15(1):382.
27.Stachs A, Göde K, Hartmann S, Stengel B, Nierling U, Dieterich M, et al. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer-size of metastases as limiting factor. SpringerPlus. 2013;2(1):350.
28.Choi JS, Kim MJ, Moon HJ, Kim E-K, Yoon JH. False negative results of preoperative axillary ultrasound in patients with invasive breast cancer: correlations with clinicopathologic findings. Ultrasound in medicine & biology. 2012;38(11):1881-6.
29.Shah AR, Glazebrook KN, Boughey JC, Hoskin TL, Shah SS,Bergquist JR, et al. Does BMI affect the accuracy of preoperativeaxillary ultrasound in breast cancer patients? Annals ofsurgical oncology. 2014;21(10):3278-83.
30.Dimitrovska MJ, Mitreska N, Lazareska M, Jovanovska ES,Dodevski A, Stojkoski A. Hook wire localization procedure and early detection of breast cancer-our experience. Open AccessMacedonian Journal of Medical Sciences. 2015;3(2):273.
31.Christodoulou D, Bajwa J, Gok G, Thomas RH, Howlett DC.Application of ultrasound-guided wire placement in head andneck cancer biopsy: where are we now? Imaging in Medicine. 2011;3(6):725.
32.Hoffmann J, Marx M, Hengstmann A, Seeger H, Oberlechner E, Helms G, et al. Ultrasound-Assisted Tumor Surgery in Breast Cancer–A Prospective, Randomized, Single-Center Study (MAC 001). Ultraschall in der Medizin-European Journal of Ultrasound. 2019;40(03):326-32.
33.Manca G, Volterrani D, Mazzarri S, Duce V, Svirydenka A, Giuliano A, et al. Sentinel lymph node mapping in breast cancer:a critical reappraisal of the internal mammary chain issue. The Quarterly Journal of Nuclear Medicine and MolecularImaging. 2014.
2.Cserni G. Axillary staging of breast cancer and the sentinel node. Journal of clinical pathology. 2000;53(10):733-41.
3.Langer I, Guller U, Viehl CT, Moch H, Wight E, Harder F, et al. Axillary lymph node dissection for sentinel lymph node micrometastases may be safely omitted in early-stage breast cancer patients: long-term outcomes of a prospective study. Annals of surgical oncology. 2009;16(12):3366-74.
4.Gradishar WJ, Anderson BO, Balassanian R, Blair SL,Burstein HJ, Cyr A, et al. NCCN guidelines insights: breast cancer, version 1.2017. Journal of the National ComprehensiveCancer Network. 2017;15(4):433-51.
5.Lyman GH, Somerfield MR, Bosserman LD, Perkins CL,Weaver DL, Giuliano AE. Sentinel lymph node biopsy forpatients with early-stage breast cancer: American Societyof Clinical Oncology clinical practice guideline update. JClin Oncol. 2017;35(5):561-4.
6.Hokimoto N, Sugimoto T, Namikawa T, Funakoshi T, Oki T, Ogawa M, et al. A novel color fluorescence navigation system for intraoperative transcutaneous lymphatic mapping and resection of sentinel lymph nodes in breast cancer: comparison with the combination of gamma probe scanning
and visible dye methods. Oncology. 2018;94(2):99-106.
7.Ahmed,M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. The lancet oncology. 2014;15(8):e351-e62.
8.Mok C, Tan SM, Zheng Q, Shi L. Network meta‐analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer. BJS open. 2019;3(4):445.
9.Cools-Lartigue J, Meterissian S. Accuracy of axillary ultrasound in the diagnosis of nodal metastasis in invasive breast cancer: a review. World journal of surgery. 2012;36(1):46-54.
10.Ganott MA, Zuley ML, Abrams GS, Lu AH, Kelly AE, Sumkin JH, et al. Ultrasound guided core biopsy versus fineneedle aspiration for evaluation of axillary lymphadenopathy in patients with breast cancer. International Scholarly Research Notices. 2014.
11.Solon JG, Power C, Al-Azawi D, Duke D, Hill AD. Ultrasound- guided core biopsy: an effective method of detecting axillary nodal metastases. Journal of the American College of Surgeons. 2012;214(1):12-7.
12.Luparia A, Campanino P, Cotti R, Lucarelli D, Durando M, Mariscotti G, et al. Role of axillary ultrasound in thepreoperative diagnosis of lymph node metastases in patients affected by breast carcinoma. La radiologia medica.2010;115(2):225-37.
13.Rissanen TJ, Mäkäräinen H, Kiviniemi HO, Suramo I. Ultrasonographically guided wire localization of non-palpable breast lesions. Journal of ultrasound in medicine. 1994;13(3):183-8.
14.Khare S, Singh T, Santosh I, Laroiya I, Singh G. Wire-andUltrasound-Guided Localization: A Novel Technique for Excision of Non-palpable Breast Tumors. Breast Cancer:Basic and Clinical Research. 2020;14:1178223420938068.
15.Mariani G, Villa G, Gipponi M, Bianchi P, Buffoni F, Agnese G, et al. Mapping sentinel lymph node in breast cancer by combined lymphoscintigraphy, blue-dye, and intraoperative gamma-probe. Cancer Biotherapy and Radiopharmaceuticals. 2000;15(3):245-52.
16.Shen J, Gilcrease MZ, Babiera GV, Ross MI, Meric‐Bernstam F, Feig BW, et al. Feasibility and accuracy of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients with documented axillary metastases. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2007;109(7):1255-63.
17.Mathelin C, Croce S, Brasse D, Gairard B, Gharbi M, Andriamisandratsoa N, et al. Methylene blue dye, an accurate dye for sentinel lymph node identification in early breast cancer. Anticancer research. 2009;29(10):4119-25.
18.Eldrageely K, Vargas MP, Khalkhali I, Venegas R. Sentinel lymph node mapping of breast cancer: a case-control studyof methylene blue tracer compared to isosulfan blue. The American Surgeon. 2004;70(10):872.
19.Olfatbakhsh A, Haghighat S, Sari F, Beheshtian T, Hashemi EA, Jafari M. The Accuracy of Preoperative Axillary Ultrasound in the Diagnosis of Lymph Node Involvement at Motamed Cancer Institute, Iran. International Journal of Cancer Management. 2020;13(4).
20.Specht MC, Fey JV, Borgen PI, Cody III HS. Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy? Journal of the American College of Surgeons. 2005;200(1):10-4.
21.Valente SA, Levine GM, Silverstein MJ, Rayhanabad JA, Weng-Grumley JG, Ji L, et al. Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Annals of surgical oncology. 2012;19(6):1825-30.
22.Chen X, Li X, Fan Z, Li J, Xie Y, Wang T, et al. Ultrasound as a replacement for physical examination in clinical stagingof axillary lymph nodes in breast cancer patients. Thoracic Cancer. 2020;11(1):48-54.
23.Goyal A, Newcombe RG, Chhabra A, Mansel RE. Factors affecting failed localisation and false-negative rates of sentinelnode biopsy in breast cancer–results of the ALMANACvalidation phase. Breast cancer research and treatment.2006;99(2):203-8.
24.Lumachi F, Norberto L, Zanella S, Marino F, Basso SM, BassoU, et al. Axillary node sampling in conjunction with sentinelnode biopsy in patients with breast cancer. A prospectivepreliminary study. Anticancer research. 2011;31(2):693-7.
25.Narui K, Ishikawa T, Kito A, Shimizu D, Chishima T, Momiyama N, et al. Observational study of blue dye-assisted four-node sampling for axillary staging in early breastcancer. European Journal of Surgical Oncology (EJSO).2010;36(8):731-6.
26.Wang Y, Dong H, Wu H, Zhang L, Yuan K, Chen H, et al. Improved false negative rate of axillary status using sentinellymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer. BMC cancer. 2015;15(1):382.
27.Stachs A, Göde K, Hartmann S, Stengel B, Nierling U, Dieterich M, et al. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer-size of metastases as limiting factor. SpringerPlus. 2013;2(1):350.
28.Choi JS, Kim MJ, Moon HJ, Kim E-K, Yoon JH. False negative results of preoperative axillary ultrasound in patients with invasive breast cancer: correlations with clinicopathologic findings. Ultrasound in medicine & biology. 2012;38(11):1881-6.
29.Shah AR, Glazebrook KN, Boughey JC, Hoskin TL, Shah SS,Bergquist JR, et al. Does BMI affect the accuracy of preoperativeaxillary ultrasound in breast cancer patients? Annals ofsurgical oncology. 2014;21(10):3278-83.
30.Dimitrovska MJ, Mitreska N, Lazareska M, Jovanovska ES,Dodevski A, Stojkoski A. Hook wire localization procedure and early detection of breast cancer-our experience. Open AccessMacedonian Journal of Medical Sciences. 2015;3(2):273.
31.Christodoulou D, Bajwa J, Gok G, Thomas RH, Howlett DC.Application of ultrasound-guided wire placement in head andneck cancer biopsy: where are we now? Imaging in Medicine. 2011;3(6):725.
32.Hoffmann J, Marx M, Hengstmann A, Seeger H, Oberlechner E, Helms G, et al. Ultrasound-Assisted Tumor Surgery in Breast Cancer–A Prospective, Randomized, Single-Center Study (MAC 001). Ultraschall in der Medizin-European Journal of Ultrasound. 2019;40(03):326-32.
33.Manca G, Volterrani D, Mazzarri S, Duce V, Svirydenka A, Giuliano A, et al. Sentinel lymph node mapping in breast cancer:a critical reappraisal of the internal mammary chain issue. The Quarterly Journal of Nuclear Medicine and MolecularImaging. 2014.
| Files | ||
| Issue | Vol 12 No 4 (2020) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/bccr.v12i4.7982 | |
| Keywords | ||
| Breast cancer Sentinel lymph node Sentinel lymph node biopsy Axillary ultrasound Lymphoscintigraphy Wire localization | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Elyasinia F, Hemmasi H, Toolabi K, Alikhassi A, Sohrabi Maralani M, Sadeghian E. Preoperative Axillary Ultrasound-guided Wire Localization and lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer Patients. Basic Clin Cancer Res. 2021;12(4):193-200.
