Investigating a Technologist-Driven Injection Technique in Lymphoscintigraphy at a Single Rural Center: A Retrospective Audit

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FIGURE 1.
Anterior and left lateral images displaying prompt radiotracer egress from injection site to axillary lymph node.

TABLE 1.

Descriptive, Technique-Related, and Surgical Follow-up Variables for Breast Cancer Cases in This Study

Variable	Result
Age (y)	64 (±11.9)
Female	140 (97.2%)
Left-sided lesion	77 (52.4%)
Lesion size (mm)	18.6 (±12.7)
Lesion type
IDC	109 (75.2%)
ILC	14 (9.7%)
DCIS	8 (5.5%)
Other	14 (9.7%)
Histologic grade
1	61 (42.1%)
2	51 (35.2%)
3	31 (21.4%)
Histologic type
HR+	113 (77.9%)
HER2-enriched	14 (9.7%)
Triple-negative	9 (6.2%)
Unknown	9 (6.2%)
Multicentric disease	17 (13.1%)
Previous intervention
Biopsy	126 (86.9%)
WLE	8 (5.5%)
Mastectomy	1 (0.7%)
None	3 (2.1%)
Unknown	7 (4.8%)
Injection site by quadrant
Upper outer	64 (44.1%)
Upper inner	37 (25.5%)
Lower outer	29 (20%)
Lower inner	14 (9.66%)
Retroareolar	1 (0.7%)
Transit on flow	100 (69%)
Time to first node, ≤30 min	136 (93.8%)
Time of last image, ≤60 min	134 (92.4%)
SPECT/CT	18 (12.6%)
IMN visualized	1 (0.7%)
Echelon nodes visualized	76 (52.4%)
SN marked	144 (99.3%)
Postlymphoscintigraphy intervention
SN hot and blue	127 (87.6%)
Concordance at surgery	140 (96.6%)
Nodes excised	2.8 (±2)
Sentinel node–positive	34 (23.5%)
Intervention after SLNB
WLE	85 (58.6%)
Mastectomy	55 (37.9%)
SLNB only	5 (3.5%)
Hookwire	54 (62.8%)

IDC = invasive ductal carcinoma; ILC = invasive lobular carcinoma; DCIS = ductal carcinoma in situ; HR+ = hormone receptor–positive; HER2 = human epidermal growth factor receptor 2; WLE = wide local excision; IMN = internal mammary node; SN = sentinel node.
Qualitative data are number and percentage; continuous data are mean ± SD.

TABLE 2.

Associations Between Age, Injection Site, or Previous Interventions or Surgery and Time to Visualization of First Node

Variable	Time to first node (min)										Total	Statistics
Variable	10	15	20	25	30	35	40	45	60	180	Total	Statistics
Age (y)												= 35.2, P = 0.508
35–44	5	0	0	1	0	0	0	0	0	0	6
45–54	24	5	0	0	2	0	0	0	0	0	31
55–64	28	2	2	1	0	1	1	0	0	0	35
65–74	29	10	0	1	1	0	0	1	0	1	43
75+	20	4	1	0	0	1	1	0	1	1	29
Total	106	21	3	3	3	2	2	1	1	2	144
Injection site												= 67.6, P = 0.001
Lower inner	10	3	1	0	0	0	0	0	0	0	14
Lower outer	22	3	0	1	1	0	1	0	0	0	28
Upper inner	28	3	1	0	1	1	1	0	0	2	37
Upper outer	46	12	1	2	0	1	0	1	1	0	64
Retroareolar	0	0	0	0	1	0	0	0	0	0	1
Total	106	21	3	3	3	2	2	1	1	2	144
Previous intervention or surgery												= 35.2, P = 0.966
Biopsy	94	16	2	3	3	1	2	1	1	2	125
Mastectomy	1	0	0	0	0	0	0	0	0	0	1
None	1	2	0	0	0	0	0	0	0	0	3
WLE	4	3	1	0	0	0	0	0	0	0	8
Total	100	21	3	3	3	1	2	1	1	2	137

TABLE 3.

Comparison of Techniques Between Present Study, EANM Guidelines, and Studies in Literature

Variable	This study	EANM guidelines (10)	Goyal et al. (16)	Kuemmel et al. (14)
Radiotracer (^99mTc-labeled)	ATC	Various radiopharmaceuticals	Colloidal albumin (^99mTc-nanocolloid)	Unspecified radiocolloid
Dose (MBq)	40	3.7–370	Same-day, 20; 2-d, 40	Maximum, 150
Injection volume (mL)	0.5	Superficial, 0.05–0.5; deep, 0.5–1	2	Variable across sites
Injection technique	Periareolar	Superficial or deep	Peritumoral	Periareolar, 1,045; peritumoral, 113
No. of injections	1	Not specified	4	Variable across sites
Dynamic imaging?	Yes	Suggested but deemed uncommon	No	Variable across sites
Delayed imaging?	No	Suggested at 1 h and 2–4 h	Yes at 3 h	No