Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland.
J Surg Oncol. 2010 Nov 1;102(6):649-55. doi: 10.1002/jso.21637.
A failure to visualize axillary sentinel nodes in lymphoscintigraphy may lead to an unsuccessful sentinel node biopsy (SNB) and subsequent axillary lymph node dissection (ALND). To avoid unnecessary ALND, a second radioisotope injection may be given but has been considered hazardous. We investigated the axillary recurrence rate after tumor-negative SNB in breast cancer patients who received a second tracer injection after axillary visualization failure in lymphoscintigraphy.
Altogether 1,309 breast cancer patients who underwent a tumor-negative SNB without an ALND were included. Two hundred seven (15.8%) patients received a second tracer injection due to visualization failure in lymphoscintigraphy and 1,102 (84.2%) did not. All patients received a blue dye injection prior to the SNB. The median follow-up time was 43 months.
No isolated cancer recurrences were diagnosed in the ipsilateral axilla among patients who received two radioisotope injections. Disease-free survival and overall survival were similar among patients with one or two radioisotope injections (P = 0.122 and P = 0.200, respectively).
Additional radiocolloid tracer injection after axillary non-visualization in lymphoscintigraphy is safe and does not increase axillary recurrence risk after tumor-negative SNB. The results suggest that such patients can be safely managed with SNB without a need to perform an ALND.
淋巴闪烁显像术未能显示腋窝前哨淋巴结可能导致前哨淋巴结活检（SNB）失败和随后的腋窝淋巴结清扫术（ALND）失败。为避免不必要的 ALND，可以进行第二次放射性同位素注射，但被认为存在危险。我们调查了在淋巴闪烁显像术显示腋窝失败后接受第二次示踪剂注射的乳腺癌患者在 SNB 阴性肿瘤后腋窝复发的发生率。
共纳入 1309 例接受阴性 SNB 且未行 ALND 的乳腺癌患者。207 例（15.8%）患者因淋巴闪烁显像术显示失败而接受第二次示踪剂注射，1102 例（84.2%）患者未接受。所有患者均在 SNB 前接受蓝色染料注射。中位随访时间为 43 个月。
在接受两次放射性同位素注射的患者中，未在同侧腋窝诊断出孤立性癌症复发。在接受一次或两次放射性同位素注射的患者中，无病生存率和总生存率相似（P=0.122 和 P=0.200）。
在淋巴闪烁显像术显示腋窝未显影后进行额外的放射性胶体示踪剂注射是安全的，并且不会增加 SNB 阴性肿瘤后腋窝复发的风险。结果表明，对于此类患者，可以安全地通过 SNB 进行管理，而无需进行 ALND。
