Lymphatic mapping and touch imprint cytological examination of sentinel lymph node in breast cancer with clinically negative axilla

الملخص EN

Fifty three women had palpable breast cancer from 1.5 to 5 cm in diameter (mean — 3.

lcm) with no palpable axillary lymph nodes (ALNs).

Their ages ranged from 23 to 72 years (mean=49.9).

The diagnosis was confirmed by tissue biopsy.

All patients were subjected to preoperative Tc 99m antimony colloid lymphoscintigraphy and intra- operative lymphatic mapping using Patent Blue Dye for sentinel lymph node (SLN) localization.

All SLNs identified intra-operatively were subjected to touch imprint cytology (TIC).

The SLNs and all ALNs were subjected to paraffin section and histopathological examination.

The success rate of lymphoscintigraphy in SLN localization was 75.5% with sensitivity of 87%.

It revealed also internal mammary lymph nodes in 2 patients (3.8%) with localization of the isotope in the upper abdomen in one of them.

The success rate of intra-operative mapping in SLN localization was 86.8% with sensitivity, specificity, positive and negative predictive values and overall accuracy of 100% for each with no false negative results.

In 31 patients single SLN/patient was found and 15 patients had multiple SLNs, from 2 to 5 /patient.

On SLN basis, TIC had 94% sensitivity, 100% specificity, 100% positive predictive value, 91.6% negative predictive value, 96.4% overall accuracy and 5.9% false negative rate.

On patient basis, it had 93.3% sensitivity, 100% specificity, 100% positive predictive value, 91.3% negative predictive value, 95.6% overall accuracy and 6.7% false negative rate.

In Conclusion, preoperative lymphoscintigraphy has the potential to identify a subgroup of patients who show no drainage into the axilla and need further intraoperative evaluation of the axilla before taking the decision of ALND.

Intraoperative mapping and SLN biopsy and its examination by TIC can make a decision intra-operatively regarding ALND so that it can be avoided in patients with no axillary metastases.