BACKGROUND: Previous mastectomy is unanimously considered to represent an absolute technical contraindication to sentinel lymph node biopsy (SLNB). METHODS: Four patients who underwent total mastectomy and plastic reconstruction with prosthesis, developed, during the follow up, a unique invasive limited local subdermic recurrence amenable to surgical excision, with clinically negative axillary nodes. In all patients preoperative lymphoscintigraphy with subdermal injection of (99m)Tc-labeled colloidal particles correctly showed an axillary sentinel lymph node (SLN). RESULTS: Metastases in SLN were detected in two patients, and a complete axillary dissection followed. The remaining two patients had a negative SLN and no axillary clearance was performed. CONCLUSIONS: In selected cases, the subdermal injection of radioisotope permits the identification of an axillary SLN, even in mastectomized patients. Despite SLNB in mastectomized patients being technically feasible, only a larger population and longer patient follow up could confirm its true predictive value. However, there are no anatomical or physiological reasons to exclude "a priori" this diagnostic opportunity. (c) 2007 Wiley-Liss, Inc.
BACKGROUND: Previous mastectomy is unanimously considered to represent an absolute technical contraindication to sentinel lymph node biopsy (SLNB). METHODS: Four patients who underwent total mastectomy and plastic reconstruction with prosthesis, developed, during the follow up, a unique invasive limited local subdermic recurrence amenable to surgical excision, with clinically negative axillary nodes. In all patients preoperative lymphoscintigraphy with subdermal injection of (99m)Tc-labeled colloidal particles correctly showed an axillary sentinel lymph node (SLN). RESULTS:Metastases in SLN were detected in two patients, and a complete axillary dissection followed. The remaining two patients had a negative SLN and no axillary clearance was performed. CONCLUSIONS: In selected cases, the subdermal injection of radioisotope permits the identification of an axillary SLN, even in mastectomized patients. Despite SLNB in mastectomized patients being technically feasible, only a larger population and longer patient follow up could confirm its true predictive value. However, there are no anatomical or physiological reasons to exclude "a priori" this diagnostic opportunity. (c) 2007 Wiley-Liss, Inc.
Authors: Antonio Toesca; Alberto Luini; Paolo Veronesi; Mattia Intra; Oreste Gentilini Journal: Breast Care (Basel) Date: 2011-06-03 Impact factor: 2.860
Authors: Diego A Vicente; Leonard R Henry; George Hahm; Peter W Soballe; DeeDee Smart Journal: World J Surg Oncol Date: 2010-07-09 Impact factor: 2.754