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10.1245/ASO.2006.02.022
Annals of Surgical Oncology 13:321-326 (2006)
© 2006 Society of Surgical Oncology
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Original Article

The Clinical Value of Parasternal Sentinel Node Biopsy in Breast Cancer

Marjut Hannele Kristiina Leidenius, MD, PhD1, Leena Anneli Krogerus, MD, PhD2, Terttu Sinikka Toivonen, MD2, Esa Antero Leppänen, MD, PhD3 and Karl Albert Johan von Smitten, MD, PhD1

1 Breast Surgery Unit, Helsinki University Hospital, P.O. Box 140, FIN-00029 HUS, Helsinki, Finland
2 Department of Pathology, Helsinki University Hospital, Haartmaninkatu 3, P.O. Box 400, FIN-00029 HUS, Helsinki, Finland
3 Department of Nuclear Medicine, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, FIN-00029 HUS, 00210 Helsinki, Finland

Correspondence: Address correspondence and reprint requests to: Marjut Hannele Kristiina Leidenius, MD, PhD; E-mail: marjut.leidenius{at}hus.fi.

Background: Lymphoscintigraphy (LS) with sentinel node (SN) biopsy is proposed to provide a feasible method to complete lymphatic staging in breast cancer. The aim of this study was to evaluate the clinical value of parasternal SN biopsy.

Methods: A total of 984 consecutive patients with clinical stage T1/2N0 invasive breast cancer who underwent LS and SN biopsy were included in the study. A prospectively collected database was used. An intratumoral injection of 50 to 145 MBq of 99mTc-labeled human albumin colloid (Nanocoll) was used for preoperative LS.

Results: LS showed the axillary SN in 844 (86%) cases and the parasternal SN in 138 (14%) cases. The median number of visualized parasternal SN was 2 (range, 1–6). Visualization of the parasternal SN was more common in patients with mediocentral tumors (81 of 399; 20%) and in patients with lateral tumors (56 of 585; 10%; P < .0001). Parasternal SNs were visualized more often, in 100 (17%) of 584 patients without axillary metastases compared with 38 (10%) of 400 patients with metastatic axillary nodes (P = .0006). Parasternal SNs were harvested successfully in 121 (88%) patients with visualization of those nodes. Parasternal SN metastases were detected in 18 patients, with a median of 1 metastasis (range, 1–4 metastases). Eight of these 18 patients were axillary node negative.

Conclusions: Parasternal SN biopsy results in upstaging in 2% of all breast cancer patients who undergo SN biopsy. The clinical value of the procedure seems insignificant, although it may influence the adjuvant treatment regimen in some patients.

Key Words: Breast cancer • Internal mammary lymph nodes • Lymph node metastases • Lymphoscintigraphy • Nodal staging • Sentinel node biopsy




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E. Madsen, P. Gobardhan, V Bongers, M Albregts, J. Burgmans, P De Hooge, J Van Gorp, and T. van Dalen
The Impact on Post-surgical Treatment of Sentinel Lymph Node Biopsy of Internal Mammary Lymph Nodes in Patients with Breast Cancer
Ann. Surg. Oncol., April 1, 2007; 14(4): 1486 - 1492.
[Abstract] [Full Text] [PDF]


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