Title:The Sentinel Node and Occult Lesion Localization (SNOLL) Technique Using a
Single Radiopharmaceutical in Non-palpable Breast Lesions
Volume: 20
Author(s): Berna Okudan, Bedri Seven*Pelin Arıcan
Affiliation:
- Department of Nuclear Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, University of Amasya, Amasya 05200, Turkey
Keywords:
Lymphoscintigraphy, Non-palpable breast lesion, Radio-guided surgery, Radiotracer, Sentinel lymph node, SNOLL.
Abstract:
Background:
In order to perform a full surgical resection on non-palpable breast lesions, a current method necessitates correct intraoperative localization.
Additionally, because it is an important prognostic factor for these patients, the examination of the lymph node status is crucial.
Objective:
The aim of this study was to evaluate the efficiency of the sentinel node and occult lesion localization (SNOLL) technique in localizing nonpalpable
breast lesions together with sentinel lymph node (SLN) using a single radiotracer, that is, nanocolloid particles of human serum albumin
(NC) labeled with technetium-99m (99mTc).
Methods:
39 patients were included, each having a single non-palpable breast lesion and clinically no evidence of axillary disease. Patients received 99mTc-
NC intratumorally on the same day as surgery under the guidance of ultrasound. Planar and single-photon emission computed
tomography/computed tomography lymphoscintigraphy were performed to localize the breast lesion and the SLN. The occult breast lesion and
SLN were both localized using a hand-held gamma-probe, which was also utilized to determine the optimal access pathway for surgery. In order to
ensure a radical treatment in a single surgical session and reduce the amount of normal tissue that would need to be removed, the surgical field was
checked with the gamma probe after the specimen was removed to confirm the lack of residual sources of considerable radioactivity.
Results:
Breast lesions were successfully localized and removed in all patients. Pathological findings revealed breast carcinoma in 11/39 patients (28%) and
benign lesions in 28 (72%). Axillary SLNs were detected in 31/39 (79.5%) patients. The metastatic involvement of SLN was only seen in two
cases.
Conclusion:
While the identification rate of the SNOLL technique performed with an intratumoral injection of 99mTc-NC as the sole radiotracer in non-palpable
breast lesions was great, it was not fully satisfactory in SLNs.
