A modified sentinel node and occult lesion localization (SNOLL) technique in non-palpable breast cancer: a pilot study
Identifieur interne : 002217 ( Main/Curation ); précédent : 002216; suivant : 002218A modified sentinel node and occult lesion localization (SNOLL) technique in non-palpable breast cancer: a pilot study
Auteurs : Giulia Anna Follacchio [Italie] ; Francesco Monteleone [Italie] ; Paolo Anibaldi [Italie] ; Giuseppe De Vincentis [Italie] ; Silvia Iacobelli [Italie] ; Raffaele Merola [Italie] ; Valerio D Razi [Italie] ; Massimo Monti [Italie] ; Vittorio Pasta [Italie]Source :
- Journal of Experimental & Clinical Cancer Research : CR [ 0392-9078 ] ; 2015.
Abstract
The spread of mammographic screening programs has allowed an increasing amount of early breast cancer diagnosis. A modern approach to non-palpable breast lesions requires an accurate intraoperative localization, in order to achieve a complete surgical resection. In addiction, the assessment of lymph node status is mandatory as it represents a major prognostic factor in these patients. The aim of this study is to evaluate the reliability of a modified technical approach using a single nanocolloidal radiotracer to localize both sentinel node and breast occult lesion.
Twenty-five patients with a single non-palpable breast lesions and clinically negative axilla were enrolled. In the same day of surgery, patients underwent intratumoral and peritumoral administration of 99mTc-labeled nanocolloid tracer under sonographic guidance. A lymphoscintigraphy was performed to localize the sentinel lymph node and its cutaneous projection was marked on the skin in order to guide the surgeon to an optimal incision. During surgery an hand-held gamma-detection probe was used to select the best surgical access route and to guide localization of both occult breast lesion and sentinel lymph node. After specimen excision, the surgical field was checked with the gamma-probe to verify the absence of residual sources of significant radioactivity, thereby ensuring a radical treatment in a single surgical session and minimizing normal tissue excision.
Both targeted breast lesion and sentinel lymph node were localized and removed at the first attempt in every patients and histopathological diagnosis of malignancy was confirmed in 25/26 samples. Non-palpable lesions were included within the surgical margins in all patients and in all samples surgical margins were free from neoplastic infiltration thus avoiding any further reintervention. Only two patients showed metastatic involvement of sentinel lymph node.
The modified sentinel node and occult lesion localization (SNOLL) technique performed with a single injection of nanocolloidal radiotracer has shown an excellent intraoperative identification rate of both non-palpable lesion and sentinel lymph node. This procedure offers, as opposed to standard techniques, an accurate, simple and reliable approach to the management of non-palpable breast cancer.
Url:
DOI: 10.1186/s13046-015-0230-x
PubMed: 26445493
PubMed Central: 4596463
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Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Monteleone, Francesco" sort="Monteleone, Francesco" uniqKey="Monteleone F" first="Francesco" last="Monteleone">Francesco Monteleone</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Anibaldi, Paolo" sort="Anibaldi, Paolo" uniqKey="Anibaldi P" first="Paolo" last="Anibaldi">Paolo Anibaldi</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Breast Unit, Department of General Surgery, “San Camillo de Lellis” Hospital, Rieti, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Unit, Department of General Surgery, “San Camillo de Lellis” Hospital, Rieti</wicri:regionArea><wicri:noRegion>Rieti</wicri:noRegion></affiliation></author><author><name sortKey="De Vincentis, Giuseppe" sort="De Vincentis, Giuseppe" uniqKey="De Vincentis G" first="Giuseppe" last="De Vincentis">Giuseppe De Vincentis</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Iacobelli, Silvia" sort="Iacobelli, Silvia" uniqKey="Iacobelli S" first="Silvia" last="Iacobelli">Silvia Iacobelli</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Merola, Raffaele" sort="Merola, Raffaele" uniqKey="Merola R" first="Raffaele" last="Merola">Raffaele Merola</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical Sciences, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="D Razi, Valerio" sort="D Razi, Valerio" uniqKey="D Razi V" first="Valerio" last="D Razi">Valerio D Razi</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical Sciences, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Via Olevano Romano 25, 00171 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of General Microsurgery and Hand Surgery, “Fabia Mater” Hospital, Via Olevano Romano 25, 00171 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Monti, Massimo" sort="Monti, Massimo" uniqKey="Monti M" first="Massimo" last="Monti">Massimo Monti</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical Sciences, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Pasta, Vittorio" sort="Pasta, Vittorio" uniqKey="Pasta V" first="Vittorio" last="Pasta">Vittorio Pasta</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical Sciences, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author></analytic><series><title level="j">Journal of Experimental & Clinical Cancer Research : CR</title><idno type="ISSN">0392-9078</idno><idno type="eISSN">1756-9966</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The spread of mammographic screening programs has allowed an increasing amount of early breast cancer diagnosis. A modern approach to non-palpable breast lesions requires an accurate intraoperative localization, in order to achieve a complete surgical resection. In addiction, the assessment of lymph node status is mandatory as it represents a major prognostic factor in these patients. The aim of this study is to evaluate the reliability of a modified technical approach using a single nanocolloidal radiotracer to localize both sentinel node and breast occult lesion.</p></sec><sec><title>Methods</title><p>Twenty-five patients with a single non-palpable breast lesions and clinically negative axilla were enrolled. In the same day of surgery, patients underwent intratumoral and peritumoral administration of <sup>99m</sup>Tc-labeled nanocolloid tracer under sonographic guidance. A lymphoscintigraphy was performed to localize the sentinel lymph node and its cutaneous projection was marked on the skin in order to guide the surgeon to an optimal incision. During surgery an hand-held gamma-detection probe was used to select the best surgical access route and to guide localization of both occult breast lesion and sentinel lymph node. After specimen excision, the surgical field was checked with the gamma-probe to verify the absence of residual sources of significant radioactivity, thereby ensuring a radical treatment in a single surgical session and minimizing normal tissue excision.</p></sec><sec><title>Results</title><p>Both targeted breast lesion and sentinel lymph node were localized and removed at the first attempt in every patients and histopathological diagnosis of malignancy was confirmed in 25/26 samples. Non-palpable lesions were included within the surgical margins in all patients and in all samples surgical margins were free from neoplastic infiltration thus avoiding any further reintervention. Only two patients showed metastatic involvement of sentinel lymph node.</p></sec><sec><title>Conclusions</title><p>The modified sentinel node and occult lesion localization (SNOLL) technique performed with a single injection of nanocolloidal radiotracer has shown an excellent intraoperative identification rate of both non-palpable lesion and sentinel lymph node. This procedure offers, as opposed to standard techniques, an accurate, simple and reliable approach to the management of non-palpable breast cancer.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kohler, Ba" uniqKey="Kohler B">BA Kohler</name></author><author><name sortKey="Sherman, Rl" uniqKey="Sherman R">RL Sherman</name></author><author><name sortKey="Howlader, N" uniqKey="Howlader N">N Howlader</name></author><author><name sortKey="Jemal, A" uniqKey="Jemal A">A Jemal</name></author><author><name sortKey="Ryerson, Ab" uniqKey="Ryerson A">AB Ryerson</name></author><author><name sortKey="Henry, Ka" uniqKey="Henry K">KA Henry</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hortobagyi, Gn" uniqKey="Hortobagyi G">GN Hortobagyi</name></author><author><name sortKey="De La Garza, Sj" uniqKey="De La Garza S">SJ de la Garza</name></author><author><name sortKey="Pritchard, K" uniqKey="Pritchard 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Monteleone</name></author><author><name sortKey="D Orazi, V" uniqKey="D Orazi V">V D'Orazi</name></author><author><name sortKey="Del Vecchio, L" uniqKey="Del Vecchio L">L Del Vecchio</name></author><author><name sortKey="Sottile, D" uniqKey="Sottile D">D Sottile</name></author><author><name sortKey="Iacobelli, S" uniqKey="Iacobelli S">S Iacobelli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pasta, V" uniqKey="Pasta V">V Pasta</name></author><author><name sortKey="D Orazi, V" uniqKey="D Orazi V">V D'Orazi</name></author><author><name sortKey="Sottile, D" uniqKey="Sottile D">D Sottile</name></author><author><name sortKey="Del Vecchio, L" uniqKey="Del Vecchio L">L Del Vecchio</name></author><author><name sortKey="Panunzi, A" uniqKey="Panunzi A">A Panunzi</name></author><author><name sortKey="Urciuoli, P" uniqKey="Urciuoli P">P Urciuoli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cremonesi, M" uniqKey="Cremonesi M">M Cremonesi</name></author><author><name sortKey="Ferrari, M" uniqKey="Ferrari M">M Ferrari</name></author><author><name sortKey="Sacco, E" uniqKey="Sacco E">E Sacco</name></author><author><name sortKey="Rossi, A" uniqKey="Rossi A">A Rossi</name></author><author><name sortKey="De Cicco, C" uniqKey="De Cicco C">C De Cicco</name></author><author><name sortKey="Leonardi, L" uniqKey="Leonardi L">L Leonardi</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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