The Impact of Lymphoscintigraphy Visualization on the Prognosis of Early Breast Cancer Patients Undergoing Sentinel Node Biopsy: A 20-year, Single-center Experience.

BACKGROUND/AIM: Patients with early breast cancer typically have a relatively favorable prognosis, although recurrence still occurs in some cases. We hypothesized that nonvisualized lymphoscintigraphy (nonvLSG) during sentinel lymph node biopsy (SLNB) might signal lymphatic obstruction caused by tumor burden, potentially leading to poorer overall survival (OS) and relapse-free survival (RFS).

PATIENTS AND METHODS

This single-center retrospective cohort study included 247 patients with early breast cancer who underwent SLNB (between 1999 and 2003). Patients were grouped into visualized lymphoscintigraphy (vLSG) and nonvLSG cohorts. Clinical characteristics, SLNB outcomes, and survival data were analyzed over a median follow-up of 12.2 years (4 months-24 years). RFS and OS were compared using Kaplan‒Meier (K-M) and Cox regression analyses.

RESULTS

Of the 247 patients, 223 (90.3%) had a vLSG, whereas 24 (9.7%) had a nonvLSG. Hormone receptor positivity was lower in the nonvLSG group (62.5% 80.3%, 0.03). K‒M survival analyses revealed no significant differences in OS or RFS between the vLSG and nonvLSG groups. Regarding OS, the log-rank test yielded 0.927, and for RFS, 0.762, indicating similar survival outcomes between the groups. At 20 years, estimated OS probabilities were 75% for the visualized group and 70% for the nonvisualized group, and RFS probabilities were approximately 70% for both groups.

CONCLUSION

Lymphoscintigraphy visualization status was not significantly associated with OS and RFS in patients with early breast cancer undergoing SLNB. This suggests that nonvisualization does not indicate a greater tumor burden or poorer prognosis. Clinically, this reassures that treatment strategies do not need to be adjusted solely based on nonvisualization in lymphoscintigraphy.