Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer

Aims: Lymphatic mapping and sentinel node (SN) biopsy in breast cancer contribute to more accurate staging, while using less invasive techniques. The aim of this study is to improve the accuracy and feasibility of this concept, increasing the identification rate of the SN, by using an alternative technique. Methods: In 70 unselected patients with primary breast cancer, of whom 51% had undergone previous excisional biopsy, lymphatic mapping was performed using 10 mCi (370 MBq) Tc-99m-nanocolloid peritumorally, combined with an intradermal blue dye tracer. Results: Lymphoscintigraphy showed one or more SN in 97% and harvest of the SN was possible in all patients (identification rate 100%). Axillary metastases were found in 39%. Sensitivity of the SN biopsy was high, both after primary surgery (93%) and after previous surgery (100%). Internal mammary lymph node biopsy following lymphatic mapping was attempted in all 24 patients (34%) with parasternal SN visible on the scan and was successful in 15 patients, revealing metastatic involvement in five patients. Conclusions: We conclude that SN biopsy, using a higher dose of peritumoral radiocolloid tracer, combined with intradermal blue dye tracer, increases feasibility in breast cancer, making this concept applicable for all patients with primary breast cancer.