ABS ePoster Library

Lymphoscintigraphy does not affect localisation rate or yield of positive nodes in sentinel node biopsy - a closed audit loop of quality assurance
Association of Breast Surgery ePoster Library. Knight H. 05/15/17; 166211; P031
Hannah Knight
Hannah Knight
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Abstract
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Introduction: Traditionally lymphoscintigrams are taken after injection of peri-areolar Technetium-99 to quantify sentinel nodes before biopsy (SNB). Our aim was to determine the necessity of lymphoscintigraphy.
Methods: 100 consecutive female patients undergoing SNB with lymphoscintigrams reported by consultant radiologists were investigated. Reported node count (RNC) was compared to SNB count using Cohen's kappa statistic. 179 consecutive female patients were then investigated without lymphoscintigrams; node localisation and positivity rates were compared.
Results: Of 100 patients with scans (all unilateral), RNC ranged from 0- 5, mean=1.84, mode=1. SNB count ranged from 1- 4, mean=1.89, mode=1. 90% of lymphoscintigraphy performed on the day of surgery. Cohen's Kappa statistic = 0.34: Fair agreement, 95%CI = 0.195 to 0.482. RNC was zero in two cases despite successful SNB.
179 consecutive patients had 180 SNB (one bilateral) with no lymphoscintigram. Excluding 3 failed localisation, SNB count range= 1-4 nodes (mean= 1.84, mode= 1). P=0.171, no difference between lymph node yield without lymphoscintigram*.
Localisation rate with scan was 100%, without scan was 98.33% - above reported rate from ALMANAC trial.
Node positivity rate with lymphoscintigram was 36% (21% macrometastases) and without was 29.38% (14.69% macrometastases). This was not significant**, p=0.30 (p=0.225 macrometastases)
* T test ** Chi-squared test
Conclusions
Lymphoscintigram did not improve localisation. Correlation between RNC and SNB count was only “fair”, and negative lymphoscintigrams did not result in failed SNB localisation.
Stopping lymphoscintigraphy did not have a statistically significant detrimental effect on SNB localisation or node positivity rate and has positive financial, time and resource implications.
Introduction: Traditionally lymphoscintigrams are taken after injection of peri-areolar Technetium-99 to quantify sentinel nodes before biopsy (SNB). Our aim was to determine the necessity of lymphoscintigraphy.
Methods: 100 consecutive female patients undergoing SNB with lymphoscintigrams reported by consultant radiologists were investigated. Reported node count (RNC) was compared to SNB count using Cohen's kappa statistic. 179 consecutive female patients were then investigated without lymphoscintigrams; node localisation and positivity rates were compared.
Results: Of 100 patients with scans (all unilateral), RNC ranged from 0- 5, mean=1.84, mode=1. SNB count ranged from 1- 4, mean=1.89, mode=1. 90% of lymphoscintigraphy performed on the day of surgery. Cohen's Kappa statistic = 0.34: Fair agreement, 95%CI = 0.195 to 0.482. RNC was zero in two cases despite successful SNB.
179 consecutive patients had 180 SNB (one bilateral) with no lymphoscintigram. Excluding 3 failed localisation, SNB count range= 1-4 nodes (mean= 1.84, mode= 1). P=0.171, no difference between lymph node yield without lymphoscintigram*.
Localisation rate with scan was 100%, without scan was 98.33% - above reported rate from ALMANAC trial.
Node positivity rate with lymphoscintigram was 36% (21% macrometastases) and without was 29.38% (14.69% macrometastases). This was not significant**, p=0.30 (p=0.225 macrometastases)
* T test ** Chi-squared test
Conclusions
Lymphoscintigram did not improve localisation. Correlation between RNC and SNB count was only “fair”, and negative lymphoscintigrams did not result in failed SNB localisation.
Stopping lymphoscintigraphy did not have a statistically significant detrimental effect on SNB localisation or node positivity rate and has positive financial, time and resource implications.
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