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Is it necessary to harvest additional lymph nodes after resection of the most radioactive sentinel lymph node in breast cancer?

Publication ,  Journal Article
Liu, L-C; Lang, JE; Jenkins, T; Lu, Y; Ewing, CA; Hwang, SE; Sokol, S; Alvarado, M; Esserman, LJ; Morita, E; Treseler, P; Leong, SP
Published in: J Am Coll Surg
December 2008

BACKGROUND: No consensus exists about the number of sentinel lymph nodes (SLNs) that should be removed based on radioactivity counts in breast cancer, although the "10% rule" is often used. We hypothesized that the node with the highest radioactivity would have the strongest probability of being a positive SLN, and we sought to determine the lowest radioactive count of a node harboring cancer. STUDY DESIGN: We retrospectively studied 332 breast cancer patients who underwent lymphoscintigraphy by injection of technetium 99m-labeled thiosulfate colloid and sentinel lymphadenectomy (SL) between 1997 and 2006, with intraoperative determination of radioactive counts of nodes by a gamma probe. All SLNs were examined by permanent sections consisting of at least 3 levels of 40- to 100-mum intervals for hematoxylin and eosin evaluation, with or without immunohistochemical staining for cytokeratins. RESULTS: Seventy-four percent of patients had more than 1 SLN removed (mean 2.8 per patient); 23.5% had SLN metastasis. Of the node-positive patients, the hottest SLN was positive in 85.9% (67 of 78). Five of the 78 patients (6.4%) with positive nodes had counts less than 10% of those of the hottest node. The lowest radioactive count of a positive SLN was 4.2% of that of the hottest node. Lymphatic mapping based on the 10% rule could greatly improve the false-negative rates compared with removing only the hottest SLN (14.1% versus 6.4%). CONCLUSIONS: Most positive SLNs had the highest radioactivity. Our institutional experience indicates that to obtain an acceptable false-negative rate, nodes should be removed until the 10% rule is met.

Duke Scholars

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

December 2008

Volume

207

Issue

6

Start / End Page

853 / 858

Location

United States

Related Subject Headings

  • Surgery
  • Sentinel Lymph Node Biopsy
  • Retrospective Studies
  • Radiopharmaceuticals
  • Radioactivity
  • Organotechnetium Compounds
  • Middle Aged
  • Lymph Nodes
  • Humans
  • Female
 

Citation

APA
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MLA
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Liu, L.-C., Lang, J. E., Jenkins, T., Lu, Y., Ewing, C. A., Hwang, S. E., … Leong, S. P. (2008). Is it necessary to harvest additional lymph nodes after resection of the most radioactive sentinel lymph node in breast cancer? J Am Coll Surg, 207(6), 853–858. https://doi.org/10.1016/j.jamcollsurg.2008.08.008
Liu, Liang-Chih, Julie E. Lang, Tyler Jenkins, Ying Lu, Cheryl A. Ewing, Shelley E. Hwang, Shima Sokol, et al. “Is it necessary to harvest additional lymph nodes after resection of the most radioactive sentinel lymph node in breast cancer?J Am Coll Surg 207, no. 6 (December 2008): 853–58. https://doi.org/10.1016/j.jamcollsurg.2008.08.008.
Liu L-C, Lang JE, Jenkins T, Lu Y, Ewing CA, Hwang SE, et al. Is it necessary to harvest additional lymph nodes after resection of the most radioactive sentinel lymph node in breast cancer? J Am Coll Surg. 2008 Dec;207(6):853–8.
Liu, Liang-Chih, et al. “Is it necessary to harvest additional lymph nodes after resection of the most radioactive sentinel lymph node in breast cancer?J Am Coll Surg, vol. 207, no. 6, Dec. 2008, pp. 853–58. Pubmed, doi:10.1016/j.jamcollsurg.2008.08.008.
Liu L-C, Lang JE, Jenkins T, Lu Y, Ewing CA, Hwang SE, Sokol S, Alvarado M, Esserman LJ, Morita E, Treseler P, Leong SP. Is it necessary to harvest additional lymph nodes after resection of the most radioactive sentinel lymph node in breast cancer? J Am Coll Surg. 2008 Dec;207(6):853–858.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

December 2008

Volume

207

Issue

6

Start / End Page

853 / 858

Location

United States

Related Subject Headings

  • Surgery
  • Sentinel Lymph Node Biopsy
  • Retrospective Studies
  • Radiopharmaceuticals
  • Radioactivity
  • Organotechnetium Compounds
  • Middle Aged
  • Lymph Nodes
  • Humans
  • Female