Skip to main content

Advertisement

SpringerLink
Log in

Intraoperative Radioisotope Injection for Sentinel Lymph Node Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative injection of technetium-99 m sulfur colloid (Tc-99) in the Nuclear Medicine Department for localizing sentinel lymph nodes (SLNs) can be extremely painful for the patient. The difficulties in scheduling and the delay in starting surgery can be frustrating for the patient and the surgeon. We hypothesized that intraoperative injection facilitated by the subareolar technique would obviate the problems associated with preoperative injection.

Methods

We performed an institutional review board-approved prospective study of patients with operable breast cancer who were candidates for an SLN biopsy from October 2002 to January 2006 at our institution. After induction of general anesthesia, patients underwent a subareolar injection of 1 mCi Tc-99 unfiltered and blue dye. Data comparing preoperative cost were collected.

Results

A total of 236 patients had 252 intraoperative SLN procedures. The mean patient age was 57.3 (range, 24-88) years. The mean ± standard deviation time from injection to incision was 25.5 ± 16.2 minutes. Identification rate was 96%, and the number of SLNs identified per patient was 1.6 ± .8. The count of SLN was 60,313 ± 134,692 with 20% SLN positivity. Tumor staging distribution was standard staging terminology for an in situ cancer (Tis) = 17 with 0% (+) SLN, T1 = 115 with 11% (+) SLN, T2 = 56 with 29% (+) SLN, T3 = 19 with 37% (+) SLN, and T4 = 4 with 50% (+) SLN. Maximum exposure to the surgeon was well below maximum, at 100 μSV/mo. Preoperative injection had an additive charge of $1325 associated with it for imaging, injection, and interpretation of images by physician.

Conclusion

Intraoperative subareolar injection of Tc-99 localizes the SLN and avoids the pain, vasovagal events, delays, and cost associated with preoperative procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Krynyckyi BR, Kim CK, Goyenechea MR, et al. Clinical breast lymphoscintigraphy: optimal techniques for performing studies, image atlas, and analysis of images. Radiographics 2004;24:121–45

    Article  PubMed  Google Scholar 

  2. Varghese P, Mostafa A, Abdel-Rahman AT, et al. Methylene blue dye versus combined dye-radioactive tracer technique for sentinel lymph node localisation in early breast cancer. Eur J Surg Oncol 2007;33:147–52

    Article  PubMed  CAS  Google Scholar 

  3. Sardi A, Spiegler E, Colandrea J, et al. The benefit of using two techniques for sentinel lymph node mapping in breast cancer. Am Surg 2002;68:24–8

    PubMed  Google Scholar 

  4. Takei H, Suemasu K, Kurosumi M, et al. Added value of the presence of blue nodes or hot nodes in sentinel lymph node biopsy of breast cancer. Breast Cancer 2006;13:179–85

    Article  PubMed  Google Scholar 

  5. Layeeque R, Kepple J, Henry-Tillman RS, et al. Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy. Ann Surg 2004;239:841–5

    Article  PubMed  Google Scholar 

  6. Dauphine CE, Khalkhali I, Vargas MP, et al. Intraoperative injection of technetium-99 m sulfur colloid is effective in the detection of sentinel lymph nodes in breast cancer. Am J Surg 2006;192:423–6

    Article  PubMed  CAS  Google Scholar 

  7. Zogakis TG, Wetherille RE, Christensen RD, et al. Intraoperative subareolar injection of 99 mTc-labeled sulfur colloid results in consistent sentinel lymph node identification. Ann Surg Oncol 2005;12:167–72

    Article  PubMed  Google Scholar 

  8. Descriptive statistics. Available at: http://www.physics.csbsju

  9. Fisher B, Slack NH. Number of lymph nodes examined and the prognosis of breast carcinoma. Surg Gynecol Obstet 1970;131:79

    PubMed  CAS  Google Scholar 

  10. Fisher B, Fisher ER, Redmond C. Ten-year results from the National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trial evaluating the use of l-phenylalanine mustard (l-PAM) in the management of primary breast cancer. J Clin Oncol 1986;4:929

    PubMed  CAS  Google Scholar 

  11. Giuliano A, Schwartz G. Summary of the proceedings of the Philadelphia Consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast. Semin Breast Dis 2002;5:110

    Google Scholar 

  12. McMasters KM, Giuliano AE, Ross MI, et al. Sentinel lymph node biopsy for breast cancer—not yet the standard of care. N Engl J Med 1998; 339:990–5

    Article  PubMed  CAS  Google Scholar 

  13. Leidenius M, Leppanen E, Krogerus L, et al. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg 2003;185:127–30

    Article  PubMed  Google Scholar 

  14. Burak WE, Hollenbeck ST, Zervos EE, et al. Sentinel lymph node biopsy results in less post operative morbidity compared with axillary lymph node dissection for breast cancer. Am J Surg 2002;183:23–7

    Article  PubMed  Google Scholar 

  15. Swenson KK, Nissen MJ, Ceronsky C, et al. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol 2002;9:745–53

    Article  PubMed  Google Scholar 

  16. Rubio IT, Korourian S, Colvert M, et al. Sentinel lymph node biopsy for the staging of breast cancer. Am J Surg 1998;176:532–7

    Article  PubMed  CAS  Google Scholar 

  17. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006;106:4–16

    Article  PubMed  Google Scholar 

  18. Krynyckyi BR, Miner M, Ragonese JM, et al. Technical aspects of performing lymphoscintigraphy: optimization of methods used to obtain images. Clin Nucl Med 2000;25:978–85

    Article  PubMed  CAS  Google Scholar 

  19. Krynyckyi BR, Zhang ZY, Kim CK, et al. Effect of high specific-activity sulfur colloid preparations on sentinel node count rates. Clin Nucl Med 2002;27:92–5

    Article  PubMed  Google Scholar 

  20. Kelly P, Winslow EH. Needle wire localization for nonpalpable breast lesions: sensations, anxiety levels, and informational needs. Oncol Nurs Forum 1996;23:639–45

    PubMed  CAS  Google Scholar 

  21. Anan K, Mitsuyama S, Kuga H, et al. Double mapping with subareolar blue dye and peritumoral green dye injections decreases the false-negative rate of dye-only sentinel node biopsy for early breast cancer: 2-site injection is more accurate than 1-site injection. Surgery 2006;139:624–9

    Article  PubMed  Google Scholar 

  22. Cundiff JD, Wang YZ, Espenan G, et al. A phase I/II trial of 125I methylene blue for one-stage sentinel lymph node biopsy. Ann Surg 2007;245:290–6

    Article  PubMed  Google Scholar 

  23. Thompson M, Korourian S, Henry-Tillman R, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Surg Oncol 2007;14:1890–5

    Article  PubMed  Google Scholar 

  24. Klimberg VS, Rubio IT, Henry R, et al. Subareolar versus peritumoral injection for location of the sentinel lymph node. Ann Surg 1999;229:860–4

    Article  PubMed  CAS  Google Scholar 

  25. Smith LF, Cross MJ, Klimberg VS. Subareolar injection is a better technique for sentinel lymph node biopsy. Am J Surg 2000;180:434–7

    Article  PubMed  CAS  Google Scholar 

  26. Layeeque R, Henry-Tillman R, Korourian S, et al. Subareolar sentinel node biopsy for multiple breast cancers. Am J Surg 2003;186:730–5

    Article  PubMed  Google Scholar 

  27. Maza S, Valencia R, Geworski L, et al. Peritumoural versus subareolar administration of technetium-99 m nanocolloid for sentinel lymph node detection in breast cancer: preliminary results of a prospective intra-individual comparative study. Eur J Nucl Med Mol Imaging 2003;30:651–6

    PubMed  Google Scholar 

  28. Kawase K, Gayed IW, Hunt KK, et al. Use of lymphoscintigraphy defines lymphatic drainage patterns before sentinel lymph node biopsy for breast cancer. J Am Coll Surg 2006;203:64–72

    Article  PubMed  Google Scholar 

  29. McMasters KM, Wong SL, Tuttle TM, et al. Preoperative lymphoscintigraphy for breast cancer does not improve the ability to identify axillary sentinel lymph nodes. Ann Surg 2000;231:724–31

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

Dr. Margaret Thompson was supported by the Susan G. Komen Breast Cancer Interdisciplinary Fellowship (M.T.) and the Fashion Footwear association of New York/QVC.

Author information

Authors and Affiliations

  1. Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, SLOT 725, Little Rock, AR, 72205-7199, USA

    Margaret Thompson MD, Ronda Henry-Tillman MD, Laura Adkins MAP, Sheilah Mumford MA, Maureen Smith RNP & V. Suzanne Klimberg MD

  2. Department of Pathology, University of Arkansas for Medical Sciences, SLOT 517, Little Rock, AR, 72205-7199, USA

    Soheila Korourian MD & V. Suzanne Klimberg MD

Authors
  1. Margaret Thompson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soheila Korourian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronda Henry-Tillman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Adkins MAP
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sheilah Mumford MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maureen Smith RNP
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Suzanne Klimberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Suzanne Klimberg MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thompson, M., Korourian, S., Henry-Tillman, R. et al. Intraoperative Radioisotope Injection for Sentinel Lymph Node Biopsy. Ann Surg Oncol 15, 3216–3221 (2008). https://doi.org/10.1245/s10434-008-0010-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0010-3

Keywords

Search

Navigation