Sentinel lymph node mapping in early‐stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery
Identifieur interne : 004311 ( Istex/Corpus ); précédent : 004310; suivant : 004312Sentinel lymph node mapping in early‐stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery
Auteurs : Giuseppe Canavese ; Marco Gipponi ; Alessandra Catturich ; Carmine Di Somma ; Carlo Vecchio ; Francesco Rosato ; Pierluigi Percivale ; Luciano Moresco ; Guido Nicol ; Bruno Spina ; Giuseppe Villa ; Pietro Bianchi ; Fausto BadellinoSource :
- Journal of Surgical Oncology [ 0022-4790 ] ; 2000-05.
Abstract
Axillary lymph node status is the most important prognostic factor in patients with operable breast cancer. Recent studies have demonstrated the possibility of identifying the sentinel lymph node (sN) as a reliable predictor of axillary lymph node status in both cutaneous melanoma and breast cancer. Sentinel lymph node identification proved feasible by either peritumoral dye injection (Patent Blue‐V) or radiodetection, with identification rates of 65–97% and 92–98%, respectively. However, some important issues need further definition, namely (a) optimization of the technique for intraoperative detection of the sN, (b) predictive value of the sN with regard to axillary lymph node status, and (c) reliability of intraoperative histology of the sN. We reviewed our experience in sN detection in patients with stage I–II breast cancer to assess the feasibility and accuracy of lymphatic mapping, by vital blue dye or radioguided surgery, and sN histology as a predictor of axillary lymph node status.
Url:
DOI: 10.1002/1096-9098(200005)74:1<61::AID-JSO14>3.0.CO;2-9
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Benzi, 10, 16132 Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Gipponi, Marco" sort="Gipponi, Marco" uniqKey="Gipponi M" first="Marco" last="Gipponi">Marco Gipponi</name><affiliation><mods:affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Catturich, Alessandra" sort="Catturich, Alessandra" uniqKey="Catturich A" first="Alessandra" last="Catturich">Alessandra Catturich</name><affiliation><mods:affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Di Somma, Carmine" sort="Di Somma, Carmine" uniqKey="Di Somma C" first="Carmine" last="Di Somma">Carmine Di Somma</name><affiliation><mods:affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Vecchio, Carlo" sort="Vecchio, Carlo" uniqKey="Vecchio C" first="Carlo" last="Vecchio">Carlo Vecchio</name><affiliation><mods:affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Rosato, Francesco" sort="Rosato, Francesco" uniqKey="Rosato F" first="Francesco" last="Rosato">Francesco Rosato</name><affiliation><mods:affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Percivale, Pierluigi" sort="Percivale, Pierluigi" uniqKey="Percivale P" first="Pierluigi" last="Percivale">Pierluigi Percivale</name><affiliation><mods:affiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Moresco, Luciano" sort="Moresco, Luciano" uniqKey="Moresco L" first="Luciano" last="Moresco">Luciano Moresco</name><affiliation><mods:affiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Nicol, Guido" sort="Nicol, Guido" uniqKey="Nicol G" first="Guido" last="Nicol">Guido Nicol</name><affiliation><mods:affiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Spina, Bruno" sort="Spina, Bruno" uniqKey="Spina B" first="Bruno" last="Spina">Bruno Spina</name><affiliation><mods:affiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Villa, Giuseppe" sort="Villa, Giuseppe" uniqKey="Villa G" first="Giuseppe" last="Villa">Giuseppe Villa</name><affiliation><mods:affiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Bianchi, Pietro" sort="Bianchi, Pietro" uniqKey="Bianchi P" first="Pietro" last="Bianchi">Pietro Bianchi</name><affiliation><mods:affiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Badellino, Fausto" sort="Badellino, Fausto" uniqKey="Badellino F" first="Fausto" last="Badellino">Fausto Badellino</name><affiliation><mods:affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Journal of Surgical Oncology</title><title level="j" type="alt">JOURNAL OF SURGICAL ONCOLOGY</title><idno type="ISSN">0022-4790</idno><idno type="eISSN">1096-9098</idno><imprint><biblScope unit="vol">74</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="61">61</biblScope><biblScope unit="page" to="68">68</biblScope><biblScope unit="page-count">8</biblScope><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>New York</pubPlace><date type="published" when="2000-05">2000-05</date></imprint><idno type="ISSN">0022-4790</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-4790</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Axillary lymph node status is the most important prognostic factor in patients with operable breast cancer. Recent studies have demonstrated the possibility of identifying the sentinel lymph node (sN) as a reliable predictor of axillary lymph node status in both cutaneous melanoma and breast cancer. Sentinel lymph node identification proved feasible by either peritumoral dye injection (Patent Blue‐V) or radiodetection, with identification rates of 65–97% and 92–98%, respectively. However, some important issues need further definition, namely (a) optimization of the technique for intraoperative detection of the sN, (b) predictive value of the sN with regard to axillary lymph node status, and (c) reliability of intraoperative histology of the sN. We reviewed our experience in sN detection in patients with stage I–II breast cancer to assess the feasibility and accuracy of lymphatic mapping, by vital blue dye or radioguided surgery, and sN histology as a predictor of axillary lymph node status.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>node</json:string><json:string>axillary</json:string><json:string>metastasis</json:string><json:string>breast cancer</json:string><json:string>lymphadenectomies</json:string><json:string>lymph</json:string><json:string>intraoperative</json:string><json:string>lymphatic</json:string><json:string>axilla</json:string><json:string>lymphadenectomy</json:string><json:string>axillary lymph node status</json:string><json:string>surg</json:string><json:string>exclusive site</json:string><json:string>lymph nodes</json:string><json:string>histologically</json:string><json:string>total axillary dissection</json:string><json:string>axillary dissection</json:string><json:string>sentinel lymphadenectomy</json:string><json:string>histology</json:string><json:string>nodal</json:string><json:string>radioguided</json:string><json:string>micrometastases</json:string><json:string>lymph node</json:string><json:string>oncol</json:string><json:string>canavese</json:string><json:string>sentinel node</json:string><json:string>sentinel</json:string><json:string>genoa</json:string><json:string>prognostic</json:string><json:string>breast cancer patients</json:string><json:string>lymphatic mapping</json:string><json:string>incision</json:string><json:string>dissection</json:string><json:string>final histology</json:string><json:string>carcinoma</json:string><json:string>surgical</json:string><json:string>detection probe</json:string><json:string>lymph node metastases</json:string><json:string>radioguided surgery</json:string><json:string>exclusive metastatic node</json:string><json:string>present study</json:string><json:string>detection rate</json:string><json:string>operable breast cancer</json:string><json:string>lymphadenectomy specimens</json:string><json:string>clinical evidence</json:string><json:string>intraoperative histology</json:string><json:string>axillary lymph node dissection</json:string><json:string>histologically nodepositive patients</json:string><json:string>istituto nazionale</json:string><json:string>lymph node metastasis</json:string><json:string>histologically patients</json:string><json:string>total mastectomy</json:string><json:string>sentinel node mapping</json:string><json:string>higher rate</json:string><json:string>sentinel lymph nodes</json:string><json:string>breast carcinoma</json:string><json:string>surg oncol</json:string></teeft></keywords><author><json:item><name>Giuseppe Canavese MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, L.go R. Benzi, 10, 16132 Genoa, Italy</json:string></affiliations></json:item><json:item><name>Marco Gipponi MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Alessandra Catturich MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Carmine Di Somma MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Carlo Vecchio MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Francesco Rosato MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Pierluigi Percivale MD</name><affiliations><json:string>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Luciano Moresco MD</name><affiliations><json:string>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Guido Nicolò MD</name><affiliations><json:string>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Bruno Spina MD</name><affiliations><json:string>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Giuseppe Villa MD</name><affiliations><json:string>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Pietro Bianchi MD</name><affiliations><json:string>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</json:string></affiliations></json:item><json:item><name>Fausto Badellino MD</name><affiliations><json:string>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>breast neoplasms</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>axillary lymph node dissection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>lymphatic mapping</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>staging</value></json:item></subject><articleId><json:string>JSO14</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><qualityIndicators><score>6.8</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1005</abstractCharCount><pdfWordCount>5021</pdfWordCount><pdfCharCount>31528</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>150</abstractWordCount></qualityIndicators><title>Sentinel lymph node mapping in early‐stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery</title><genre><json:string>article</json:string></genre><host><title>Journal of Surgical 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type="first">Giuseppe</forename><surname>Canavese</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, L.go R. Benzi, 10, 16132 Genoa, Italy</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Marco</forename><surname>Gipponi</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0002"><persName><forename type="first">Alessandra</forename><surname>Catturich</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Carmine</forename><surname>Di Somma</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Carlo</forename><surname>Vecchio</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0005"><persName><forename type="first">Francesco</forename><surname>Rosato</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0006"><persName><forename type="first">Pierluigi</forename><surname>Percivale</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0007"><persName><forename type="first">Luciano</forename><surname>Moresco</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0008"><persName><forename type="first">Guido</forename><surname>Nicolò</surname><roleName type="degree">MD</roleName></persName><affiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0009"><persName><forename type="first">Bruno</forename><surname>Spina</surname><roleName type="degree">MD</roleName></persName><affiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0010"><persName><forename type="first">Giuseppe</forename><surname>Villa</surname><roleName type="degree">MD</roleName></persName><affiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0011"><persName><forename type="first">Pietro</forename><surname>Bianchi</surname><roleName type="degree">MD</roleName></persName><affiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0012"><persName><forename type="first">Fausto</forename><surname>Badellino</surname><roleName type="degree">MD</roleName></persName><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy<address><country key="IT"></country></address></affiliation></author><idno type="istex">8E3D0D38D978F44E0D4A0558CCAB1F8C4234C173</idno><idno type="DOI">10.1002/1096-9098(200005)74:1<61::AID-JSO14>3.0.CO;2-9</idno><idno type="unit">JSO14</idno><idno type="toTypesetVersion">file:JSO.JSO14.pdf</idno></analytic><monogr><title level="j" type="main">Journal of Surgical Oncology</title><title level="j" type="alt">JOURNAL OF SURGICAL ONCOLOGY</title><idno type="pISSN">0022-4790</idno><idno type="eISSN">1096-9098</idno><idno type="book-DOI">10.1002/(ISSN)1096-9098</idno><idno type="book-part-DOI">10.1002/1096-9098(200005)74:1<>1.0.CO;2-7</idno><idno type="product">JSO</idno><imprint><biblScope unit="vol">74</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="61">61</biblScope><biblScope unit="page" to="68">68</biblScope><biblScope unit="page-count">8</biblScope><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>New York</pubPlace><date type="published" when="2000-05"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><head>Abstract</head>
Background and Objectives
<p>Axillary lymph node status is the most important prognostic factor in patients with operable breast cancer. Recent studies have demonstrated the possibility of identifying the sentinel lymph node (sN) as a reliable predictor of axillary lymph node status in both cutaneous melanoma and breast cancer. Sentinel lymph node identification proved feasible by either peritumoral dye injection (Patent Blue‐V) or radiodetection, with identification rates of 65–97% and 92–98%, respectively. However, some important issues need further definition, namely (a) optimization of the technique for intraoperative detection of the sN, (b) predictive value of the sN with regard to axillary lymph node status, and (c) reliability of intraoperative histology of the sN. We reviewed our experience in sN detection in patients with stage I–II breast cancer to assess the feasibility and accuracy of lymphatic mapping, by vital blue dye or radioguided surgery, and sN histology as a predictor of axillary lymph node status.</p>
Methods
<p>Two groups of patients (55 and 48) were recruited between May 1996 and May 1997 and between October 1997 and February 1998; the patients of the first series underwent vital blue dye lymphatic mapping only, whereas those of the second series had a combined approach with both vital blue dye mapping and radioguided detection of the sN.</p>
Results
<p>In the first set of patients, the sN was identified in 36/55 patients (65.4%); sN histology predicted axillary lymph node status with a 77% sensitivity (10/13), a 100% specificity (23/23), an 88.5% negative predictive value (23/26), and an overall 91.5% accuracy (33/36). The sN was the quasi‐elective site of lymph node metastases because in clinically N0 patients nodal involvement was 20‐fold more likely at histology in sN than in non‐sN (30% and 1.5%, respectively). In the second set of patients, 49 lymphadenectomies were performed because 1 patient had bilateral breast cancer; the sN was identified in 45/49 lymphadenectomies (92%). The sN was intraoperatively negative at frozen‐section examination in 33 cases, and final histology confirmed the absence of metastases in 31/33 cases (94%), whereas in 2 cases (6%) micrometastases only were detected. Final histology of the sN predicted axillary lymph node status with an 87.5% sensitivity (14/16), a 100% specificity (29/29), a 93.5% negative predictive value (29/31), and an overall 95.5% accuracy (43/45).</p>
Conclusions
<p>Sentinel lymphadenectomy can be better accomplished when both mapping techniques (vital blue dye and radioguided surgery) are used. In this group of patients, agreement of intraoperative histology of the sN with the final diagnosis was 94%, and sN histology accurately predicted axillary lymph node status in 43/45 lymphadenectomy specimens (95.5%) in which an sN was identified. J. Surg. Oncol. 2000;74:61–68. © 2000 Wiley‐Liss, Inc.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="kwd1">breast neoplasms</term><term xml:id="kwd2">axillary lymph node dissection</term><term xml:id="kwd3">lymphatic mapping</term><term xml:id="kwd4">staging</term></keywords></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/8E3D0D38D978F44E0D4A0558CCAB1F8C4234C173/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>John Wiley & Sons, Inc.</publisherName><publisherLoc>New York</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1096-9098</doi><issn type="print">0022-4790</issn><issn type="electronic">1096-9098</issn><idGroup><id type="product" value="JSO"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="JOURNAL OF SURGICAL ONCOLOGY">Journal of Surgical Oncology</title><title type="short">J. Surg. Oncol.</title></titleGroup></publicationMeta><publicationMeta level="part" position="10"><doi origin="wiley" registered="yes">10.1002/1096-9098(200005)74:1<>1.0.CO;2-7</doi><numberingGroup><numbering type="journalVolume" number="74">74</numbering><numbering type="journalIssue">1</numbering></numberingGroup><coverDate startDate="2000-05">May 2000</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="14" status="forIssue"><doi origin="wiley" registered="yes">10.1002/1096-9098(200005)74:1<61::AID-JSO14>3.0.CO;2-9</doi><idGroup><id type="unit" value="JSO14"></id></idGroup><countGroup><count type="pageTotal" number="8"></count></countGroup><copyright ownership="publisher">Copyright © 2000 Wiley‐Liss, Inc.</copyright><eventGroup><event type="manuscriptAccepted" date="1999-09-29"></event><event type="firstOnline" date="2000-06-01"></event><event type="publishedOnlineFinalForm" date="2000-06-01"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.2 mode:FullText source:HeaderRef result:HeaderRef" date="2010-03-10"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-01"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-30"></event></eventGroup><numberingGroup><numbering type="pageFirst">61</numbering><numbering type="pageLast">68</numbering></numberingGroup><correspondenceTo>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, L.go R. Benzi, 10, 16132 Genoa, Italy</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JSO.JSO14.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="7"></count><count type="referenceTotal" number="35"></count><count type="wordTotal" number="4834"></count></countGroup><titleGroup><title type="main" xml:lang="en">Sentinel lymph node mapping in early‐stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery</title><title type="short" xml:lang="en">Sentinel Node Mapping in Breast Cancer</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Giuseppe</givenNames><familyName>Canavese</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Marco</givenNames><familyName>Gipponi</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Alessandra</givenNames><familyName>Catturich</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Carmine</givenNames><familyName>Di Somma</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Carlo</givenNames><familyName>Vecchio</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Francesco</givenNames><familyName>Rosato</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Pierluigi</givenNames><familyName>Percivale</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Luciano</givenNames><familyName>Moresco</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au9" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Guido</givenNames><familyName>Nicolò</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au10" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Bruno</givenNames><familyName>Spina</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au11" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Giuseppe</givenNames><familyName>Villa</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au12" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Pietro</givenNames><familyName>Bianchi</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au13" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Fausto</givenNames><familyName>Badellino</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="IT" type="organization"><unparsedAffiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="IT" type="organization"><unparsedAffiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="IT" type="organization"><unparsedAffiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="IT" type="organization"><unparsedAffiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">breast neoplasms</keyword><keyword xml:id="kwd2">axillary lymph node dissection</keyword><keyword xml:id="kwd3">lymphatic mapping</keyword><keyword xml:id="kwd4">staging</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><section xml:id="abs1-1"><title type="main">Background and Objectives</title><p>Axillary lymph node status is the most important prognostic factor in patients with operable breast cancer. Recent studies have demonstrated the possibility of identifying the sentinel lymph node (sN) as a reliable predictor of axillary lymph node status in both cutaneous melanoma and breast cancer. Sentinel lymph node identification proved feasible by either peritumoral dye injection (Patent Blue‐V) or radiodetection, with identification rates of 65–97% and 92–98%, respectively. However, some important issues need further definition, namely (a) optimization of the technique for intraoperative detection of the sN, (b) predictive value of the sN with regard to axillary lymph node status, and (c) reliability of intraoperative histology of the sN. We reviewed our experience in sN detection in patients with stage I–II breast cancer to assess the feasibility and accuracy of lymphatic mapping, by vital blue dye or radioguided surgery, and sN histology as a predictor of axillary lymph node status.</p></section><section xml:id="abs1-2"><title type="main">Methods</title><p>Two groups of patients (55 and 48) were recruited between May 1996 and May 1997 and between October 1997 and February 1998; the patients of the first series underwent vital blue dye lymphatic mapping only, whereas those of the second series had a combined approach with both vital blue dye mapping and radioguided detection of the sN.</p></section><section xml:id="abs1-3"><title type="main">Results</title><p>In the first set of patients, the sN was identified in 36/55 patients (65.4%); sN histology predicted axillary lymph node status with a 77% sensitivity (10/13), a 100% specificity (23/23), an 88.5% negative predictive value (23/26), and an overall 91.5% accuracy (33/36). The sN was the quasi‐elective site of lymph node metastases because in clinically N0 patients nodal involvement was 20‐fold more likely at histology in sN than in non‐sN (30% and 1.5%, respectively). In the second set of patients, 49 lymphadenectomies were performed because 1 patient had bilateral breast cancer; the sN was identified in 45/49 lymphadenectomies (92%). The sN was intraoperatively negative at frozen‐section examination in 33 cases, and final histology confirmed the absence of metastases in 31/33 cases (94%), whereas in 2 cases (6%) micrometastases only were detected. Final histology of the sN predicted axillary lymph node status with an 87.5% sensitivity (14/16), a 100% specificity (29/29), a 93.5% negative predictive value (29/31), and an overall 95.5% accuracy (43/45).</p></section><section xml:id="abs1-4"><title type="main">Conclusions</title><p>Sentinel lymphadenectomy can be better accomplished when both mapping techniques (vital blue dye and radioguided surgery) are used. In this group of patients, agreement of intraoperative histology of the sN with the final diagnosis was 94%, and sN histology accurately predicted axillary lymph node status in 43/45 lymphadenectomy specimens (95.5%) in which an sN was identified. J. Surg. Oncol. 2000;74:61–68. © 2000 Wiley‐Liss, Inc.</p></section></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Sentinel lymph node mapping in early‐stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Sentinel Node Mapping in Breast Cancer</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Sentinel lymph node mapping in early‐stage breast cancer: Technical issues and results with vital blue dye mapping and radioguided surgery</title></titleInfo><name type="personal"><namePart type="given">Giuseppe</namePart><namePart type="family">Canavese</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, L.go R. Benzi, 10, 16132 Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marco</namePart><namePart type="family">Gipponi</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alessandra</namePart><namePart type="family">Catturich</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carmine</namePart><namePart type="family">Di Somma</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carlo</namePart><namePart type="family">Vecchio</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesco</namePart><namePart type="family">Rosato</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pierluigi</namePart><namePart type="family">Percivale</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Luciano</namePart><namePart type="family">Moresco</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Experimental and Clinical Oncology, University of Genoa, School of Medicine, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Guido</namePart><namePart type="family">Nicolò</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bruno</namePart><namePart type="family">Spina</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Pathology Laboratory, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Giuseppe</namePart><namePart type="family">Villa</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pietro</namePart><namePart type="family">Bianchi</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Nuclear Medicine Service, DIMI, University of Genoa, School of Medicine, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Fausto</namePart><namePart type="family">Badellino</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Surgical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>John Wiley & Sons, Inc.</publisher><place><placeTerm type="text">New York</placeTerm></place><dateIssued encoding="w3cdtf">2000-05</dateIssued><dateValid encoding="w3cdtf">1999-09-29</dateValid><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">7</extent><extent unit="references">35</extent><extent unit="words">4834</extent></physicalDescription><abstract>Axillary lymph node status is the most important prognostic factor in patients with operable breast cancer. Recent studies have demonstrated the possibility of identifying the sentinel lymph node (sN) as a reliable predictor of axillary lymph node status in both cutaneous melanoma and breast cancer. Sentinel lymph node identification proved feasible by either peritumoral dye injection (Patent Blue‐V) or radiodetection, with identification rates of 65–97% and 92–98%, respectively. However, some important issues need further definition, namely (a) optimization of the technique for intraoperative detection of the sN, (b) predictive value of the sN with regard to axillary lymph node status, and (c) reliability of intraoperative histology of the sN. We reviewed our experience in sN detection in patients with stage I–II breast cancer to assess the feasibility and accuracy of lymphatic mapping, by vital blue dye or radioguided surgery, and sN histology as a predictor of axillary lymph node status.</abstract><abstract>Two groups of patients (55 and 48) were recruited between May 1996 and May 1997 and between October 1997 and February 1998; the patients of the first series underwent vital blue dye lymphatic mapping only, whereas those of the second series had a combined approach with both vital blue dye mapping and radioguided detection of the sN.</abstract><abstract>In the first set of patients, the sN was identified in 36/55 patients (65.4%); sN histology predicted axillary lymph node status with a 77% sensitivity (10/13), a 100% specificity (23/23), an 88.5% negative predictive value (23/26), and an overall 91.5% accuracy (33/36). The sN was the quasi‐elective site of lymph node metastases because in clinically N0 patients nodal involvement was 20‐fold more likely at histology in sN than in non‐sN (30% and 1.5%, respectively). In the second set of patients, 49 lymphadenectomies were performed because 1 patient had bilateral breast cancer; the sN was identified in 45/49 lymphadenectomies (92%). The sN was intraoperatively negative at frozen‐section examination in 33 cases, and final histology confirmed the absence of metastases in 31/33 cases (94%), whereas in 2 cases (6%) micrometastases only were detected. Final histology of the sN predicted axillary lymph node status with an 87.5% sensitivity (14/16), a 100% specificity (29/29), a 93.5% negative predictive value (29/31), and an overall 95.5% accuracy (43/45).</abstract><abstract>Sentinel lymphadenectomy can be better accomplished when both mapping techniques (vital blue dye and radioguided surgery) are used. In this group of patients, agreement of intraoperative histology of the sN with the final diagnosis was 94%, and sN histology accurately predicted axillary lymph node status in 43/45 lymphadenectomy specimens (95.5%) in which an sN was identified. J. Surg. Oncol. 2000;74:61–68. © 2000 Wiley‐Liss, Inc.</abstract><subject lang="en"><genre>keywords</genre><topic>breast neoplasms</topic><topic>axillary lymph node dissection</topic><topic>lymphatic mapping</topic><topic>staging</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Surgical Oncology</title></titleInfo><titleInfo type="abbreviated"><title>J. Surg. 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