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Intraoperative Subareolar Injection of 99mTc-Labeled Sulfur Colloid Results in Consistent Sentinel Lymph Node Identification

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Abstract

Background

Preoperative parenchymal or peritumoral (PT) injection of 99mTc-labeled sulfur colloid (TcSC) is the standard method for sentinel lymph node (SLN) identification in patients with breast cancer. Limitations of this method include variable identification rates, slow transit times, and painful injections. We hypothesize that TcSC will travel to the SLN within minutes after injection into the subareolar (SA) lymphatics, thus making an intraoperative injection technique feasible.

Methods

One hundred twenty-two women with invasive breast cancer were enrolled onto this prospective study. Immediately after the induction of general anesthesia, patients were injected with 1 to 2 mCi of filtered TcSC in the SA location. Then, 5 mL of 1% isosulfan blue dye was injected into the PT location. The SLN or SLNs were identified as radioactive, blue, or both and removed for pathologic evaluation.

Results

The mean patient age was 56 years. The mean tumor size was 1.5 cm. In 86.1% of patients, a transcutaneous axillary “hot spot” was identified by handheld gamma probe. The mean time from TcSC injection to axillary incision was 17.6 minutes. At least one SLN was identified in 99.2% of patients. The mean number of SLNs identified per patient was 1.83. The mean count of radioactive SLNs was 2715 cps. In 97.2% of patients, blue SLNs were also radioactive.

Conclusions

TcSC injected into the SA lymphatics rapidly drains to the SLN. The radioactive SLN is easily and quickly identified after an intraoperative SA TcSC injection. The simplicity of this method eliminates the inherent problems associated with standard PT injection.

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ACKNOWLEDGMENTS

Supported by Minnesota Medical Foundation Grant 3233-9227-03. The authors thank Mary Knatterud, PhD, for editorial assistance.

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Authors and Affiliations

  1. John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, California, 90404

    Theresa G. Zogakis MD

  2. Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, Minnesota, 55426

    Robert E. Wetherille MD, Robert D. Christensen MD, Kevin J. Ose MD, Joel D. Friedman MD, Marybeth Colbert MD & Charles A. Svendsen MD

  3. United Hospital, 333 North Smith Avenue, St. Paul, Minnesota, 55102

    Omer K. Sanan MD

  4. Department of Surgery, University of Minnesota, 420 Delaware St. S.E., Minneapolis, Minnesota, 55455

    Todd M. Tuttle MD

Authors
  1. Theresa G. Zogakis MD
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  2. Robert E. Wetherille MD
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  3. Robert D. Christensen MD
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  4. Kevin J. Ose MD
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  5. Joel D. Friedman MD
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  6. Marybeth Colbert MD
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  7. Charles A. Svendsen MD
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  8. Omer K. Sanan MD
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  9. Todd M. Tuttle MD
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Corresponding author

Correspondence to Todd M. Tuttle MD.

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Zogakis, T.G., Wetherille, R.E., Christensen, R.D. et al. Intraoperative Subareolar Injection of 99mTc-Labeled Sulfur Colloid Results in Consistent Sentinel Lymph Node Identification. Ann Surg Oncol 12, 167–172 (2005). https://doi.org/10.1245/ASO.2005.04.021

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  • DOI: https://doi.org/10.1245/ASO.2005.04.021

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