Dra. Cristina Noblía.Instituto de Oncología “Angel.H.Roffo”.Universidad de Buenos Aires

Joint International Oncology Congress

May 27-May 29,2013

Armando Giuliano Stanley Leong

Sentinella Symposium Moderators : A.Testori, MD and S. Vidal-Sicart, MD

Financial Disclosure

Dr Noblìa has no relevant financial relationships to disclose

Breast Surgery Departament Instituto Instituto de de Oncología Oncología “Angel H. “Angel H. Roffo Roffo ” UBA ” UBA

PERIODS

• First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + SNB • Fourth Period :SENTINELLA

FIRST PERIOD • BLUE DYE (PATENT BLUE). • 3cc Peritumoral • Massage for 5 minutes.

Transverse axillary incision just inferior to the hair-bearing region of the axilla.

The blue lymphatic channel was followed proximally and distally until the first node was identified

All the blue nodes were excised

1997 ONLY BLUE DYE

N= 65 SN = 1.8

Level I : 95%

Level II : 5%

IR= 84%

FN= 20%

Side effects Blue Hives

Blue Tatoo

Generalised Rash

PERIODS

• First Period : Blue Dye • Second Period : Radioisotope +

Blue Dye • Third Period : PET/CT + TGS • Fourth Period :SENTINELLA

SECOND PERIOD (2000) • Radioisotope + lymphoscintigraphy

•Gamma Probe •Patent blue

Tc 99 labelled human albumin colloide particles in 0.2 ml saline

SURGERY

The Probe was used to identify the hot SN with its accoustic signal

ADVANTAGES OF USING RADIOISOTOPE

• 1.Technically easier and requires less tissue dissection.

• 2.Lymphoscintigraphy can

determinate if there is extra axillary drainage.

COMBINED TECHNIQUES

• Sentinel Node Identification is facilitated when the two techniques are used together, since the additional visual guidance of the blue dye simplifies the operative procedure.

• The simultaneous use of both techniques may

accelerate the learning curve for each method used alone.

N = 95 IR = 98% SN= 2

86% HOT and BLUE Level I = 97%

14% HOT Level II = 3%

No axillary dissection

IR : 95%

FN : 5%

PERIODS

• First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + TGS • Fourth Period :SENTINELLA

Utility of 18FDG – PET/CT and Sentinel Node Biopsy for axillary staging in primary breast

cancer: Roffo PET/CT 1 Trial

N = 54

T1T2NO

RESULTS PET / CT IN AXILA

• PET / CT (-): 45 (83%). • 6 presented metastases

in the sentinel node. • 3 had microMETS

• FALSE NEGATIVE : 40%. • SENSITIVITY: 60%. • VPN : 87%.

CONCLUSION • PET/CT has low sensitivity for detecting axillary

nodes in breast cancer at initial stages because of its low spacial resolution (greater than 6 mm).

• A negative PET/CT does not replace the sentinel

node biopsy • A positive PET/CT would indicate the need to

make an axillary dissection even in clinically negative axilla .

PERIODS

• First Period : Blue Dye • Second Period : Radioisotope + Blue Dye • Third Period : PET/CT + TGS • Fourth Period :SENTINELLA

Fourth Period SENTINELLA

• N:42 PATIENTS • T1T2NO. • In 2 cases

additional nodes were discovered with Sentinella that the gamma probe didn’t detect.

Axillary bed

Second SN

SENTINELLA

• IS USEFUL WHEN • FIRSTLY: • Deep SN : A) Overweight patients

Deep Node

b) Sentinel Node in Internal Mammary Chain

IN SITU EX VIVO

Secondly: SENTINELLA is useful for detecting nodes that are difficult for the probe because of the closeness to the tumor

(Shine Through)

FINALLY SNOLL

Radio- Guided Surgery for Ethiological Diagnosis of Solitary Rib Lesions

Dr Osvaldo Salariato Oncology Institute Angel H. Roffo

N: 18

14 neoplasic disease

7 benign lesions

Accurate identification of the lesion

Precise Approach Minimal Incision

Radio-Guided Surgery for Ethiological Diagnosis of

Solitary Rib Lesions

No residual mass in the surgical site

SENTINELLA

PROVIDES IMAGES THAT CLEARLY SHOW THE COMPLETE EXCISION OF THE SN

Departamento de Mastología: Dr.Cresta Morgado Dra.Cristina Noblía

Dr. González Dr. Armanasco

Dra. Azar Dra. Montoya

Dr. Ipiña

Departamento de Medicina Nuclear:

Dra. Parma Dra. Zarlenga Dra.Armesto

Dra San Martin Gabriela.

Dra Lidia Katz Departamento de Anatomía

Patológica: Dra. Gorostidi

Departamento de Oncología:

Dra. Mickiewicz Dra. Alvarez