Biopsie sentinelové uzliny v chirurgickéléčbě karcinomu prsu: prospektivní studie

Biopsy of the Sentinel Node in Surgical Treatment ofBreast Cancer: Prospective Study

Objective:
Authors report the validity and accuracy of lymphatic mapping with sentinel nodebiopsy in patients with early breast cancer between 1998 and 2000.Type of study: Prospective study.Location: Department of Surgery, Atlas Hospital Zlin.Methods used: Lymphatic mapping and sentinel node biopsy using patentblue in patients withbreast cancer was performed between 1998 and 2000. Combination of patentblue and radiocoloidNanocoll Nycomed Amersham has been used from 2000. C-Track device (Care Wise Medical ProductMorgan Hill) was applied for detection of radiocoloid in sentinel node. Gamma probe intraoperativelylocalised sentinel nodes. Lymphoscintigraphy was performed routinely. Patients weretested with routine hematoxylin & eosin staining. When the H&E staining in sentinel nodes wasnegative the immunohistochemical procedure was used. Following identification of sentinel nodes,axillary node dissection was applied. Axillary node dissection was abandoned by patientswith tumor T1 and sentinel node negative.Results: In 124 cases, the sentinel node was successfully identified. 122 patients were women withunilateral and one woman with bilateral cancer. 1 was a male. Of these 124 cases 60 were node-positiveand sentinel nodes metastasis was in 26 cases only. 1375 nonsentinel nodes were examined(a mean 13.4). 268 sentinel nodes were examined (a mean 2.2). Hematoxylin and eosin staining wasused routinely and if no tumor was identified then imunohistochemical cytokeratin staining wasperformed. Imunohistochemical staining was used in 21 cases. Only in one patient micrometastaseswere identified. Three sentinel nodes were negative in patient with axillary disease.Conclusion: This study demonstrates that sentinel node biopsy in patients with early breastcancer is safe and highly accurate and can be used to avoid axillary lymph node dissection.

Key words:
breast cancer, axillary lymph node dissection, sentinel node, lymphatic mapping, lymphoscintigraphy,micrometastases, H&E and imunohistochemical stain