Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes

Umberto Veronesi, Giovanni Paganelli, Viviana Galimberti, Giuseppe Viale, Stefano Zurrida, Marilia Bedoni, Alberto Costa, Concetta De Cicco, James G. Geraghty, Alberto Luini, Virgilio Sacchini, Paolo Veronesi

Research output: Contribution to journalArticle

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Abstract

Background. Axillary lymph-node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary nodes are free of disease. This raises questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph node (sentinel node) initially receives malignant cells from a breast carcinoma and, second, whether a clear sentinel node reliably forecasts a disease-free axilla. Methods. In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium-99m. This tracer was injected subdermally, close to the tumour site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive node (sentinel node). During breast surgery, a hand-held γ-ray detector probe was used to locate the sentinel node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The sentinel node was tagged separately from other nodes. Permanent sections of all removed nodes were prepared for pathological examination. Findings. From the sentinel node, we could accurately predict axillary lymph-node status in 156 (97.5%) of the 160 patients in whom a sentinel node was identified, and in all cases (45 patients) with tumours less than 1.5 cm in diameter. In 32 (38%) of the 85 cases with metastatic axillary nodes, the only positive node was the sentinel node. Interpretation. In the large majority of patients with breast cancer, lymphoscintigraphy and γ-probe-guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel-node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease-free.

Original languageEnglish
Pages (from-to)1864-1867
Number of pages4
JournalLancet
Volume349
Issue number9069
DOIs
Publication statusPublished - Jun 28 1996

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Dissection
Lymph Nodes
Breast Neoplasms
Biopsy
Axilla
Lymph Node Excision
Breast
cyhalothrin
Lymphoscintigraphy
Technetium
Ambulatory Surgical Procedures
Serum Albumin
Early Diagnosis
Neoplasms
Hand
Skin

ASJC Scopus subject areas

  • Medicine(all)

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Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. / Veronesi, Umberto; Paganelli, Giovanni; Galimberti, Viviana; Viale, Giuseppe; Zurrida, Stefano; Bedoni, Marilia; Costa, Alberto; De Cicco, Concetta; Geraghty, James G.; Luini, Alberto; Sacchini, Virgilio; Veronesi, Paolo.

In: Lancet, Vol. 349, No. 9069, 28.06.1996, p. 1864-1867.

Research output: Contribution to journalArticle

Veronesi, Umberto ; Paganelli, Giovanni ; Galimberti, Viviana ; Viale, Giuseppe ; Zurrida, Stefano ; Bedoni, Marilia ; Costa, Alberto ; De Cicco, Concetta ; Geraghty, James G. ; Luini, Alberto ; Sacchini, Virgilio ; Veronesi, Paolo. / Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. In: Lancet. 1996 ; Vol. 349, No. 9069. pp. 1864-1867.
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abstract = "Background. Axillary lymph-node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary nodes are free of disease. This raises questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph node (sentinel node) initially receives malignant cells from a breast carcinoma and, second, whether a clear sentinel node reliably forecasts a disease-free axilla. Methods. In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium-99m. This tracer was injected subdermally, close to the tumour site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive node (sentinel node). During breast surgery, a hand-held γ-ray detector probe was used to locate the sentinel node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The sentinel node was tagged separately from other nodes. Permanent sections of all removed nodes were prepared for pathological examination. Findings. From the sentinel node, we could accurately predict axillary lymph-node status in 156 (97.5{\%}) of the 160 patients in whom a sentinel node was identified, and in all cases (45 patients) with tumours less than 1.5 cm in diameter. In 32 (38{\%}) of the 85 cases with metastatic axillary nodes, the only positive node was the sentinel node. Interpretation. In the large majority of patients with breast cancer, lymphoscintigraphy and γ-probe-guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel-node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease-free.",
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AU - Veronesi, Umberto

AU - Paganelli, Giovanni

AU - Galimberti, Viviana

AU - Viale, Giuseppe

AU - Zurrida, Stefano

AU - Bedoni, Marilia

AU - Costa, Alberto

AU - De Cicco, Concetta

AU - Geraghty, James G.

AU - Luini, Alberto

AU - Sacchini, Virgilio

AU - Veronesi, Paolo

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N2 - Background. Axillary lymph-node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary nodes are free of disease. This raises questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph node (sentinel node) initially receives malignant cells from a breast carcinoma and, second, whether a clear sentinel node reliably forecasts a disease-free axilla. Methods. In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium-99m. This tracer was injected subdermally, close to the tumour site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive node (sentinel node). During breast surgery, a hand-held γ-ray detector probe was used to locate the sentinel node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The sentinel node was tagged separately from other nodes. Permanent sections of all removed nodes were prepared for pathological examination. Findings. From the sentinel node, we could accurately predict axillary lymph-node status in 156 (97.5%) of the 160 patients in whom a sentinel node was identified, and in all cases (45 patients) with tumours less than 1.5 cm in diameter. In 32 (38%) of the 85 cases with metastatic axillary nodes, the only positive node was the sentinel node. Interpretation. In the large majority of patients with breast cancer, lymphoscintigraphy and γ-probe-guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel-node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease-free.

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