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ABSTRACT: Evaluation of Lymph Node Status in Male Breast Cancer
Patients: A Role for Sentinel Lymph Node Biopsy
Sentinel lymph node (SLN) biopsy is rapidly emerging as an
alternative to axillary lymph node dissection (ALND) for many
female breast cancer patients. In contrast, ALND remains the
standard of care for male breast cancer patients with similar
tumors.
We evaluated the results of SLN biopsy in male breast
cancer patients with clinically negative axillae. This study
included all male breast cancer patients who underwent SLN biopsy
at our institution between October 1999 and 2000.
All patients
had negative axillae on clinical examination and sonography. All
patients underwent preoperative lymphoscintigraphy followed by
SLN biopsy performed using a combination of isosulfan blue dye
and technetium Tc 99m sulfur colloid. Tc 99m sulfur colloid was
injected at a dose of 2.5 mCi 24 h before surgery (four patients)
or 0.5 mCi 2-4 h before surgery (three patients).
Intraoperatively,
5 ml of 1% isosulfan blue was injected adjacent to the breast tumor
or biopsy cavity prior to SLN biopsy. A gamma probe was used
intraoperatively in order to localize SLNs.
Any node that was blue
or associated with ex vivo radioactivity counts at least 10 times
higher than the axillary background counts was defined as a SLN.
SLNs were assessed intraoperatively using touch preparation
cytologic examination. Completion ALND was performed if nodal
metastases were identified.
Seven patients, 44-76 years of age,
were included in the study. Preoperative lymphoscintigraphy
identified SLNs in five patients. Intraoperatively, SLNs were
identified in all seven patients. SLNs were identified in six
patients using the gamma probe and in all seven patients using
blue dye. The mean number of SLNs encountered was 2.9. Findings
on touch preparation cytology correlated with findings on the final
pathological analysis examination in all patients.
One patient had
a positive SLN, this patient had three additional positive nodes
identified in his completion ALND specimen. Three patients with
negative SLNs had been elected preoperatively to undergo ALND
regardless of findings on SLN biopsy, no positive lymph nodes were
identified in the ALND specimens from these patients.
These findings
compare favorably with findings reported in the literature regarding
SLN biopsy in female breast cancer patients.
Blue dye injection and
radioisotope injection were complementary. SLN biopsy should be
considered for axillary staging in male breast cancer patients with
clinically negative axillae.
[11/22/2002; Breast Cancer Research and Treatment]
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