Journal of General Practice

Importance of Lymphoscintigraphy to Find Sentinel Ganglion in the Context of Malignant Neoplasm of Breast

Abstract

Rafael Macedo

Aim: To assess the importance of the sentinel ganglion (GS) detection technique by lymphoscintigraphy in order to avoid lymphedema of the upper limbs in malignant neoplasms of the breast. The sentinel ganglion is the first ganglion of the lymphatic chain to drain the lymph from the primary tumor. The lymphoscintigraphy allows to identify this ganglion, to facilitate its removal by the surgeon and to be analyzed by the pathological anatomy through an extemporaneous analysis in order to avoid axillary emptying in case of negative analysis for metastases.
Material and Methods: All lymphoscintigraphy were performed with the BrigthView Philips model camera at the SESARAM, E.P.E.. All of these studies followed the same protocol according to the EANM guidelines. An anamnesis of the patient was carried out, the explanation of the procedure and the positioning of the patient according to the protocol in force. A dynamic study was performed immediately after administration of the radiopharmaceutical and then static, anterior, oblique and lateral images. After processing the acquired images and marking GS on the skin with the aid of the Europrobe 3 probe, clinical reports were performed. For the analysis of the data, we selected female patients with breast neoplasia, who underwent the examination between June 23, 2017 and March 22, 2018, aged between 33 and 88 years.
Results: Through the evaluation of the sample of 56 users we can verify that this technique allowed to avoid axillary emptying in 39 patients. Of the 56 patients, 2 had bilateral breast neoplasia, 33 right breast neoplasm and 21 left breast cancer. Of the 2 patients with bilateral malignant neoplasia, one presented both negative ganglia and the other presented negative right GS and positive left GS and consequent axillary emptying. Of the 33 patients with neoplasia of the right breast 8, they emptied, and of the 21 patients with left breast neoplasia, 9 performed emptying.
Conclusions: According to the data obtained in the SESARAM E.P.E. Nuclear Medicine study, it was verified that lymphoscintigraphy allowed to avoid axillary emptying in 39 patients, which corresponds to 70% of the sample. It is confirmed that this diagnostic technique is an asset in the preservation of the lymphatic chain. The availability of this technique in a hospital regimen for the detection of sentinel ganglion in the Regional Health Service is considered important to avoid the limitations associated with axillary emptying and consequent improvement in the quality of life of these patients".