Scientific paper
Injection of 99mTc-labeled sulfur colloid the day before operation for breast cancer sentinel lymph node mapping is as successful as injection the day of operation

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004
https://doi.org/10.1016/j.amjsurg.2004.08.053Get rights and content

Abstract

Background

We investigated whether the timing of injection of 99mTc-labeled sulfur colloid (radiocolloid) significantly influenced the success of breast cancer sentinel lymph node (SLN) mapping.

Methods

Review of a prospective SLN database. Five hundred forty-six consecutive breast SLN mapping patients were analyzed. A dual radiocolloid/blue dye technique was used in all patients.

Results

The SLN identification rate was similar among those patients injected the day prior (100%) and those injected the day of operation (99%, P = 0.14). A “hot” SLN was identified in 99% of patients injected the day prior and in 97% (P = 0.17) injected the day of operation. The mean number of SLNs was greater among those injected the day prior (2.71) than among those injected the day of operation (2.33, P = 0.01). There were no differences in the rates of SLN metastases.

Conclusions

Radiocolloid injection the day before operation is an acceptable and logistically advantageous technique for breast cancer SLN mapping.

Section snippets

Materials and methods

Institutional review board approval was obtained for this study. We reviewed the prospective database at the Mayo Clinic in Scottsdale, AZ, of all patients who have undergone intraoperative lymphatic mapping and SLN biopsy for breast carcinoma at our institution. Medical records were reviewed to supplement the database information. Between 1995 and August 2003, 750 SLN biopsies were attempted in 735 patients. Fifteen patients underwent bilateral SLN biopsies for bilateral malignancies.

Results

From August 2000 through August 2003, 546 patients underwent breast SLN mapping procedures. Of theses, 352 patients (64%) underwent SLN mapping with radiocolloid injected the day of operation and 194 (36%) the day before operation. Patient and tumor characteristics were similar between the two groups (Table 1). A larger percentage of patients undergoing radiocolloid injection the day of operation had their injection performed intradermal/subdermal (84%) than those injected the day before

Comments

Although SLN mapping and biopsy has become widely accepted for the staging of breast cancer patients, there is still much to be learned about this procedure in these patients. Most institutions currently use a combined blue dye and radiocolloid technique. This is supported by reports of false-negative rates being up to twice as high with single-agent SLN mapping [7]. Early reports of SLN mapping with radiocolloid describe injection the day of operation [8], [9]. Most subsequent published series

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