Original Paper Med Princ Pract 2003;12:17–22 DOI: 10.1159/000068161 Lymphoscintigraphy in the Sentinel Lymph Node Technique for Breast Tumor: Value of Early and Late Images for the Learning Curve C. Rousseau a L. Campion b C. Curtet a J.M. Classe c F. Dravet c M. Fiche d C. Sagan d J.F. Chatal a I. Resche a a Nuclear Medicine, b Statistics, c Surgery, and d Pathology Units, René Gauducheau Cancer Center, Nantes-Saint Herblain, France Received: April 2, 2002 Revised: August 3, 2002 C. Rousseau Centre René Gauducheau Service de Médecine Nucléaire, Boulevard Monod F–44805 Saint Herblain Cedex (France) Tel. +33 2 40 67 99 31, Fax +33 2 40 67 97 31, E-Mail c-rousseau@nantes.fnclcc.fr ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2003 S. Karger AG, Basel 1011–7571/03/0121–0017$19.50/0 Accessible online at: www.karger.com/mpp Key Words Breast cancer W Lymphatic mapping W Sentinel node Abstract As the performance of early (H+1 to H+4) and late (D1) lymphoscintigraphic images raises organizational prob- lems in outpatient surgery for breast cancer, only early images are generally obtained. The present study evalu- ated whether two series of images are better than one and defined the advantages of both methodologies. One hundred and eighteen patients with infiltrating breast carcinoma (T 0, T 1 and T 2 ) were included in the study: 87 in group A (early and late images) and 31 in group B (only early images). All patients received two peritu- moral injections of 99m Tc-sulfur colloid, 15–18 MBq (group A) and ! 15 MBq (group B). During the operation, the patent blue bye technique was associated with ra- dioactivity detection. The two groups were comparable for histological type and tumor size and localization. Suc- cessful localization of sentinel nodes on early lympho- scintigraphic images was significantly greater for group B. The identification of a sentinel node focus on early lymphoscintigraphy increased by 10% during the study. Sentinel node detection by the isotopic method alone, or the two methods combined, was comparable for both groups. In radioactivity detection, the count rate for sen- tinel nodes versus background (contralateral breast) was similar for the two groups. During the learning phase, two series of images gave a definite advantage. Subse- quently, lymphoscintigraphy performed at +2 h was suf- ficient (the results for the two groups became indistin- guishable). Copyright © 2003 S. Karger AG, Basel Introduction Breast cancer screening has led to the treatment of an increasing number of subclinical cancers, but many axil- lary resections have proved negative because 75% of small tumors (! 2 cm) are free of axillary metastases [1]. Nonetheless, the presence of an axillary node metastasis is a major prognostic factor in therapeutic strategy, and node status can only be determined by axillary resection and histopathological analysis of the nodes removed. Yet axillary resection, though essential to initial staging [2], can lead to postoperative morbidity, both immediately (lymphoceles) and subsequently (pain and lymphede- mas). Given these circumstances, pre-and intraoperative sentinel node (SN) detection would seem to be an attrac- tive alternative. The SN concept was introduced in 1977 by Cabanas [3] for cancer of the penis and then applied to the staging