Topic: Evolution of the different sentinel node biopsy identification methods in breast cancer Speaker: Cristina Noblía

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