O Kraft1. 1. Klinika nukleární medicíny FNsP, Ostrava, Poruba. otakar.kraft@fnspo.cz
Abstract
BACKGROUND: Detection of SLN in some types of malignant tumors is important for the developing of a therapeutic strategy, determining the stage and predicting prognosis. It is possible to avoid removal of whole groups of lymph nodes. We have three detection methods--lymphoscintigraphy, blue dye and gamma probe. The aim of this study was to compare these methods in breast cancer and malignant melanoma patients, to compare three radiopharmaceuticals, to assess the detection of non-axillary SLN in breast cancer. METHODS AND RESULTS: SLN were examined in 214 melanoma patients (94 men, average age 58.4 yrs; 120 women, average age 52.6 yrs), in 147 breast cancer patients (145 women and 2 men, average age 59.3 yrs). We used combination of lymphoscintigraphy, intraoperative blue dye and gamma probe. Lymphoscintigraphy was done with three radiopharmaceuticals--Nanocis, Senti-Scint and Nanocoll. SLN were subjected to histological and immunohistochemical examination. The best success rate of detection of SLN was by means of lymphoscintigraphy and the lowest by blue dye. The differences among the three radiopharmaceuticals were not large, however, in average Nanocoll detected more SLNs in malignant melanoma patients. In the breast cancer patients the false-negative rate of SLN was 5.17%, sensitivity 94.83%, negative predictive value 96.7%, accuracy 98%, positive predictive value 100%, specificity 100%. CONCLUSIONS: Parallel use of scintigraphy. gamma probe, and blue dye is the highly effective and indispensable for the SLN detection. In breast cancer patients it is advisable to take biopsy samples from the displayed non-axillary SLNs for improving the effects of the method.
BACKGROUND: Detection of SLN in some types of malignant tumors is important for the developing of a therapeutic strategy, determining the stage and predicting prognosis. It is possible to avoid removal of whole groups of lymph nodes. We have three detection methods--lymphoscintigraphy, blue dye and gamma probe. The aim of this study was to compare these methods in breast cancer and malignant melanomapatients, to compare three radiopharmaceuticals, to assess the detection of non-axillary SLN in breast cancer. METHODS AND RESULTS:SLN were examined in 214 melanomapatients (94 men, average age 58.4 yrs; 120 women, average age 52.6 yrs), in 147 breast cancerpatients (145 women and 2 men, average age 59.3 yrs). We used combination of lymphoscintigraphy, intraoperative blue dye and gamma probe. Lymphoscintigraphy was done with three radiopharmaceuticals--Nanocis, Senti-Scint and Nanocoll. SLN were subjected to histological and immunohistochemical examination. The best success rate of detection of SLN was by means of lymphoscintigraphy and the lowest by blue dye. The differences among the three radiopharmaceuticals were not large, however, in average Nanocoll detected more SLNs in malignant melanomapatients. In the breast cancerpatients the false-negative rate of SLN was 5.17%, sensitivity 94.83%, negative predictive value 96.7%, accuracy 98%, positive predictive value 100%, specificity 100%. CONCLUSIONS: Parallel use of scintigraphy. gamma probe, and blue dye is the highly effective and indispensable for the SLN detection. In breast cancerpatients it is advisable to take biopsy samples from the displayed non-axillary SLNs for improving the effects of the method.