Dunedin Public Hospital, Dunedin, New Zealand.
Bankstown Lidcombe Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2020 Dec;90(12):2510-2515. doi: 10.1111/ans.16402. Epub 2020 Oct 30.
Mammographic screening has enabled earlier detection of breast cancer, with 25-35% of malignancies being non-palpable at diagnosis. Accurate removal and sentinel node biopsy for staging these lesions are crucial to successful management. Both these aspects are achieved by peritumoural localization with radioisotope and lymphoscintigraphy for sentinel lymph node (SN) mapping using the sentinel node and occult lesion localization (SNOLL) technique. This study reports SNOLL outcomes in a large cohort of women with non-palpable breast cancers to assess its performance and promote its logistic advantages.
This retrospective cohort study used data from BreastSurgANZ Quality Audit supplemented with private case notes. Inclusion criteria were females >18 years, with invasive breast cancer that was asymptomatic and non-palpable at presentation, who underwent SNOLL (n = 450). Primary outcomes were proportion of successful lesion localization, proportion of patients requiring re-excision and volume of tissue excised. Secondary outcomes focused on lymphoscintigraphy success rate in detecting sentinel nodes and SN positivity rates.
Tumours were successfully removed with the initial SNOLL procedure in 449 cases (99.8%). The re-excision rate was 15.1% (n = 68). The mean total excision volume was 54.69 cm (95% CI 51.49-57.88 cm ; range 2.75-195.33 cm ), with a mean closest circumferential margin of 7.05 mm (95% CI 6.60-7.49 mm; range 0 to ≥10 mm). Lymphoscintigraphy was successful in 96.9% (n = 436) of cases. Sentinel nodes were successfully identified and removed in 99.6% (n = 448) of cases. SN positivity rate was 18.4%.
SNOLL is an efficient and effective technique for localizing non-palpable invasive breast lesions while simultaneously identifying sentinel nodes.
乳腺 X 线筛查使乳腺癌得以早期发现，其中 25-35%的恶性肿瘤在诊断时触诊不可触及。准确切除和前哨淋巴结活检对于这些病变的分期至关重要，有助于成功管理。这两个方面都可以通过放射性同位素和淋巴闪烁显像术进行肿瘤周围定位来实现，用于前哨淋巴结 (SN) 绘图的前哨淋巴结和隐匿性病变定位 (SNOLL) 技术。本研究报告了在大量非触诊性乳腺癌女性中使用 SNOLL 的结果，以评估其性能并促进其逻辑优势。
这项回顾性队列研究使用了 BreastSurgANZ 质量审计的数据，并补充了私人病例记录。纳入标准为 >18 岁的女性，患有浸润性乳腺癌，在就诊时无症状且触诊不可触及，接受 SNOLL（n=450）。主要结局是成功定位病变的比例、需要再次切除的患者比例和切除的组织体积。次要结局集中在检测前哨淋巴结的淋巴闪烁显像成功率和 SN 阳性率。
449 例（99.8%）肿瘤通过初始 SNOLL 手术成功切除。再次切除率为 15.1%（n=68）。平均总切除体积为 54.69cm（95%CI 51.49-57.88cm；范围 2.75-195.33cm），平均最近周径切缘为 7.05mm（95%CI 6.60-7.49mm；范围 0 至≥10mm）。96.9%（n=436）的病例淋巴闪烁显像成功。99.6%（n=448）的病例成功识别和切除了前哨淋巴结。SN 阳性率为 18.4%。
SNOLL 是一种有效且有效的技术，可用于定位非触诊性浸润性乳腺病变，同时识别前哨淋巴结。
