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World Journal of Surgical Oncology

, 5:132

First Online: 17 November 2007Received: 25 August 2007Accepted: 17 November 2007

Abstract

BackgroundSentinel lymph node SLN procedure is now a widely accepted method of LN staging in selected invasive breast cancers unifocal, size ≤ 2 cm, clinically N0, without previous treatment. Complete axillary clearance is no longer needed if the SLN is negative. However, the oncological safety of this procedure remains to be addressed in randomized clinical trials. One main pitfall is the failure to visualize SLN, resulting in incorrect tumor staging, leading to suboptimal treatment or axillary recurrence. Operative gamma cameras have therefore been developed to optimize the SLN visualization and the quality control of surgery.

Case presentationA 44-year-old female patient with a 14-mm infiltrative ductal carcinoma underwent the SLN procedure. An operative gamma camera was used during and after the surgery. The conventional lymphoscintigraphy showed only one SLN, which was also detected by the operative gamma camera, then removed and measured 9.6 kBq. It was analyzed by frozen sections, showing no cancer cells. During this analysis, the exploration of the axillary area with the operative gamma camera enabled the identification of a second SLN with low activity 0.5 kBq that conventional lymphoscintigraphy, surgical probe and blue staining had failed to visualize. Histological examination revealed a macrometastasis. Axillary clearance was then performed, followed by a postoperative image proving that no SLN remained. Therefore, the use of the operative gamma camera prevented an under-estimation of staging which would have resulted in a suboptimal treatment for this patient.

ConclusionThis case report illustrates that an efficient operative gamma camera may be able to decrease the risk of false negative rate of the SLN procedure, and could be an additional tool to control the quality of the surgery.

Trial RegistrationClinicalTrials.gov Identifier: NCT00357487

AbbreviationsFNRfalse negative rate

FOVfield of view

OGCoperative gamma camera

SLNsentinel lymph node

Electronic supplementary materialThe online version of this article doi:10.1186-1477-7819-5-132 contains supplementary material, which is available to authorized users.

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Autor: Carole Mathelin - Samuel Salvador - Sabrina Croce - Norosoa Andriamisandratsoa - Daniel Huss - Jean-Louis Guyonnet

Fuente: https://link.springer.com/







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