Sentinella Mini‐Symposium Moderators: Alessandro Testori and Sergi Vidal‐Sicart (non‐CME session)
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Topic: Evolution of the different sentinel node biopsy identification methods in breast cancer Speaker: Cristina Noblía
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Sentinella Mini‐Symposium Moderators: Alessandro Testori and Sergi Vidal‐Sicart (non‐CME session)
- 1. Dra. Cristina Noblía.Instituto de Oncología “Angel.H.Roffo”.Universidad de Buenos Aires Joint International Oncology Congress May 27-May 29,2013 Armando Giuliano Stanley Leong Sentinella Symposium Moderators : A.Testori, MD and S. Vidal-Sicart, MD
- 2. Financial Disclosure Dr Noblìa has no relevant financial relationships to disclose
- 3. Breast Surgery Departament InstitutoInstituto dede OncologíaOncología “Angel H.“Angel H. RoffoRoffo” UBA” UBA
- 4. PERIODS • First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + SNB • Fourth Period :SENTINELLA
- 5. FIRST PERIOD • BLUE DYE (PATENT BLUE). • 3cc Peritumoral • Massage for 5 minutes.
- 6. Transverse axillary incision just inferior to the hair-bearing region of the axilla.
- 7. The blue lymphatic channel was followed proximally and distally until the first node was identified All the blue nodes were excised
- 8. 1997 ONLY BLUE DYE N= 65 SN = 1.8 Level I : 95% Level II : 5% IR= 84% FN= 20%
- 9. Side effects Blue Hives Blue Tatoo Generalised Rash
- 10. PERIODS • First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + TGS • Fourth Period :SENTINELLA
- 11. SECOND PERIOD (2000) • Radioisotope + lymphoscintigraphy •Gamma Probe •Patent blue Tc 99 labelled human albumin colloide particles in 0.2 ml saline
- 12. SURGERY The Probe was used to identify the hot SN with its accoustic signal
- 13. ADVANTAGES OF USING RADIOISOTOPE • 1.Technically easier and requires less tissue dissection. • 2.Lymphoscintigraphy can determinate if there is extra axillary drainage.
- 14. COMBINED TECHNIQUES • Sentinel Node Identification is facilitated when the two techniques are used together, since the additional visual guidance of the blue dye simplifies the operative procedure. • The simultaneous use of both techniques may accelerate the learning curve for each method used alone.
- 15. N = 95 IR = 98% SN= 2 86% HOT and BLUE Level I = 97% 14% HOT Level II = 3%
- 16. No axillary dissection IR : 95% FN : 5%
- 17. PERIODS • First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + TGS • Fourth Period :SENTINELLA
- 18. Utility of 18FDG – PET/CT and Sentinel Node Biopsy for axillary staging in primary breast cancer: Roffo PET/CT 1 Trial N = 54 T1T2NO
- 19. RESULTS PET / CT IN AXILA • PET / CT (-): 45 (83%). • 6 presented metastases in the sentinel node. • 3 had microMETS • FALSE NEGATIVE : 40%. • SENSITIVITY: 60%. • VPN : 87%.
- 20. CONCLUSION • PET/CT has low sensitivity for detecting axillary nodes in breast cancer at initial stages because of its low spacial resolution (greater than 6 mm). • A negative PET/CT does not replace the sentinel node biopsy • A positive PET/CT would indicate the need to make an axillary dissection even in clinically negative axilla .
- 21. PERIODS • First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + TGS • Fourth Period :SENTINELLA
- 22. Fourth Period SENTINELLA • N:42 PATIENTS • T1T2NO. • In 2 cases additional nodes were discovered with Sentinella that the gamma probe didn’t detect. Axillary bed Second SN
- 23. SENTINELLA • IS USEFUL WHEN • FIRSTLY: • Deep SN : A) Overweight patients
- 24. Deep Node b) Sentinel Node in Internal Mammary Chain IN SITU EX VIVO
- 25. Secondly: SENTINELLA is useful for detecting nodes that are difficult for the probe because of the closeness to the tumor (Shine Through)
- 26. FINALLY SNOLL
- 27. Radio- Guided Surgery for Ethiological Diagnosis of Solitary Rib Lesions Dr Osvaldo Salariato Oncology Institute Angel H. Roffo N: 18 14 neoplasic disease 7 benign lesions
- 28. Accurate identification of the lesion Precise Approach Minimal Incision
- 29. Radio-Guided Surgery for Ethiological Diagnosis of Solitary Rib Lesions No residual mass in the surgical site
- 30. SENTINELLA PROVIDES IMAGES THAT CLEARLY SHOW THE COMPLETE EXCISION OF THE SN
- 31. Departamento de Mastología: Dr.Cresta Morgado Dra.Cristina Noblía Dr. González Dr. Armanasco Dra. Azar Dra. Montoya Dr. Ipiña Departamento de Medicina Nuclear: Dra. Parma Dra. Zarlenga Dra.Armesto Dra San Martin Gabriela. Dra Lidia Katz Departamento de Anatomía Patológica: Dra. Gorostidi Departamento de Oncología: Dra. Mickiewicz Dra. Alvarez