Breast Cancer Coverage from Every Angle

Role of Lymphoscintigraphy in Sentinel Lymph Node Biopsy for Early Breast Cancer

By: Kelly M. Hennessey, PhD
Posted: Tuesday, August 13, 2019

A study conducted by Sherko Kuemmel, PhD, MD, of Kliniken Essen-Mitte, Essen, Germany, and colleagues found that surgeon knowledge of preoperative lymphoscintigraphy results seemed to have no effect on the staging accuracy of sentinel lymph node biopsy (SLNB) in women with early breast cancer.  Their analyses showed a mean number of histologically detected sentinel lymph nodes of 2.21 with lymphoscintigraphy and 2.26 without it, demonstrating that SLNB is equally effective regardless of surgeon knowledge of lymphoscintigraphy results. These findings were reported in the Journal of Clinical Oncology.

This multicenter, phase III trial included 1,198 patients with cNO early breast cancer or extensive/high-grade ductal carcinoma in situ, 1,163 of whom were the focus of the modified intention-to-treat analysis. The study patients were randomly assigned 1:1 to receive SLNB with (n = 585) or without (n = 578) knowledge of lymphoscintigraphy findings in 23 German and Swiss breast centers.

“As the false-negative rate of SLNB correlates with the number of resected sentinel lymph nodes (SLNs), our primary endpoint was the mean number of histologically detected SLNs per patient,” explained the authors. To establish noninferiority of SNLB without lymphoscintigraphy, the stratified one-sided 95% confidence interval for the difference (without lymphoscintigraphy – with lymphoscintigraphy) in the mean number of histologically detected SLNs had to be great than –0.27 (10% noninferiority margin).

The investigators concluded that the accuracy of SLNB is equally effective if performed without preoperative lymphoscintigraphy in patients with clinically node-negative primary untreated breast cancer while also speeding up preoperative workflow and reducing costs. “We have no reason to believe that omission of lymphoscintigraphy would result in a risk of understaging or undertreatment,” the authors noted.

Disclosure: The study authors’ disclosure information can be found at

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