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Percutaneous Biopsy and Sentinel Lymphadenectomy

Minimally Invasive Diagnosis and Treatment of Nonpalpable Breast Cancer

¹ Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
² Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

OBJECTIVE. The purpose of this study was to determine the usefulness of the combination of percutaneous imaging-guided large-core breast biopsy and sentinel lymphadenectomy in the diagnosis and treatment of nonpalpable invasive breast cancer.

MATERIALS AND METHODS. Retrospective review revealed 200 consecutive nonpalpable breast cancers diagnosed by percutaneous imaging-guided large-core biopsy and treated with surgery that included sentinel lymphadenectomy. Percutaneous breast biopsy was performed with stereotactic or sonographic guidance with an automated core needle or vacuum-assisted biopsy probe. Sentinel lymphadenectomy was performed with intradermal injection of a radioisotope and intraparenchymal injection of blue contrast agent. Technical success was defined as identification of sentinel nodes at surgery. Medical records were reviewed.

RESULTS. Technical success rate was 200 (100%) of 200. In 158 (79%) of 200 cancers, sentinel nodes were tumor-free, and axillary dissection was avoided. In three (2%) of 200 carcinomas, the sentinel nodes were negative for tumor, but nonsentinel nodes suspicious on intraoperative palpation were excised and found by frozen section analysis to contain tumor. Tumor was found in sentinel nodes in 39 (20%) of 200 carcinomas; axillary dissection, performed in 31 of these 39 women, revealed additional tumor in nonsentinel nodes in seven (23%). A single surgical procedure was performed for 164 (82%) of 200 carcinomas; the breast was preserved in 191 (96%) of these 200 carcinomas.

CONCLUSION. Percutaneous imaging-guided large-core breast biopsy and sentinel lymphadenectomy provide a minimally invasive approach to the diagnosis and treatment of women with nonpalpable invasive breast cancers.

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