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Sentinel lymph node biopsy in breast cancer: The approach in day surgery under local
anaesthesia for quality-of-life and significant cost reduction.
Ricci F, Capuano LG, Di Legge P, Polistena A, Saralli E, Violante A, Scala T, Cannas P,
Pacchiarotti A, Cianni R, Fanelli G, Bellardini P, De Masi C.
Santa Maria Goretti Hospital, Latina, Italy; Lega Italiana per la Lotta contro i Tumori (LILT),
Latina, Italy
Background: Sentinel lymph node biospy (SLNB) is widely used in the management of breast
cancer patients without axillary metastases or inflammatory breast cancer (IBC).
Methods: From Jan. 1st 2006 through Dic. 31st 2011 we performed 302 SLNB at St. M. Goretti
Hospital. Mammary carcinoma was diagnosed as malignant by aspiration citology and/or biospy. In
all cases with positive citology or biospy, we performed quadrantectomy and SLNB at the same
time. All patients underwent pre-operative lymphoscintigraphy with intradermal pericicatritial
and/or periareola injection of 12-15 MBq 99Tc colloidal albumin particles 50-80 nm size range, in
0,2 ml saline solution. We never used vital blue dye. All patients underwent surgical treatment 3-12
h. later. We performed SLNB and quadrantectomy in day surgery (DS) and local anaesthesia (LA)
with 2% of Carbocaine. Axillary incision was 3-4 cm. This study was approved by an ethics
committee, was discussed with all patients and informed consent was obtained. Purpose of the study
is to investigate the approach in DS under LA for quality of life and significant cost reduction.
Results: Six patients underwent pre-operative lymphoscintigraphy the radiotracer did not show any
sentinel lymph node (SLN), in five cases we performed axillary dissection (AD). In one case of
young patient who had previously been treated with chemotherapy for non-Hodgkin’s lymphoma,
negative positron emission tomography (PET), we performed quadrantectomy without AD. In three
cases the axilla was positive. In four cases of multifocal (MF) and two of multicentric (MC)
invasive breast cancer, the SLN was identified in axilla and SLNB was perfomed. SLNB in MF and
MC tumors was similar to unifocal cancers. Only one case of MC cancer the SLN was positive. Six
patients classified T4b according to AJCC, were treated with neoadjuvant chemotherapy (NC). The
axilla was negative to ultrasound (US), PET and citology. After completion of NC, lymphatic
mapping was able to identify SLN and we performed SLNB. In these patients SLN was negative.
In two cases of male cancer the axilla was negative to clinical examination, in both cases SLN was
positive for macrometastases. Six cases showed axillary isolated tumor cells (ITC). Eighteen
micrometastases. Thirty-two macrometastases. In two case of negative SLN there was a positive
second palpable lymph node. One case showed a double SLN in the axilla and internal mammary
chain, only the internal mammary lymph node was positive. The SLN identification rate was 99%.
After surgery we distributed a questionnaire to the patients about the acceptability of this approach.
Conclusions: The oncological results are absolutely reliable. This approach is safe, well accepted
by patients who reported better quality of life (99%). We observed less incidence of nosocomial
infection and loss of working days. As regards hospital logistics, operations in DS and LA can be
easily managed, leading to an significant cost reduction over 55% less expensive than the same
operation performed under general anaesthesia, involving one night stay in hospital.
Acknowledgements - F. Lunardi, M. Schembari, A. Cipolla, E. Fantin, L. Saltarelli, G. Pucci,
A. Di Furia, I. Di Pirro, N. Murroni, A.M. De Cave, I. Di Stefano, M. Masi, A. Novaga, E. Ganelli,
A. Rossi, Volontari LILT.
Cancer Res; 72(24Suppl.) December 15, 2012
Cancer Research