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Technical Effects of Adding 1 % Lidocaine to Technetium Sulfur Colloid for Sentinel Lymphatic Mapping in Early Breast Cancer: Analysis of Data from a Double-blind Randomized Controlled Trial

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

Abstract

Background

A practice standard in sentinel lymph node (SLN) mapping in breast cancer is intradermal injection of technetium-99m sulfur colloid (Tc-99m), resulting in significant patient discomfort and pain. A previous randomized controlled trial showed that adding lidocaine to Tc-99m significantly reduced radioisotope injection-related pain. We tested whether 1 % lidocaine admixed with Tc-99m affects feasibility of SLN mapping.

Methods

Between January 2006 and April 2009, 140 patients with early breast cancer were randomly assigned (1:1:1:1) to receive standard topical 4 % lidocaine cream and intradermal Tc-99m (control) or to one of three other study groups: topical placebo cream and injection of Tc-99m containing sodium bicarbonate (NaHCO3), 1 % lidocaine, or both. All SLN data were collected prospectively.

Results

Study groups were comparable for clinicopathological parameters. As previously reported, the addition of 1 % lidocaine to the radioisotope solution significantly improved patient comfort. Overall SLN identification rate in the trial was 93 %. Technical aspects of SLN biopsy were similar for all groups, including time from injection to operation, first SLN (SLN 1) gamma probe counts, ex vivo counts for SLN 1 and SLN 2, and axillary bed counts. SLN identification rates were comparable statistically: control (96 %), lidocaine (90 %), sodium bicarbonate (97 %), and sodium bicarbonate–lidocaine (90 %). The control group had a significantly higher SLN 2/SLN 1 ex vivo count ratio, and the number of SLNs detected was significantly reduced in the lidocaine versus no-lidocaine groups (p < 0.05).

Conclusions

Addition of 1 % lidocaine to standard radioisotope solution for SLN mapping in breast cancer is associated with fewer SLNs detected, but it does not appear to compromise SLN identification.

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Acknowledgment

We acknowledge Tiffany Felix and Nancy Kwon for their invaluable assistance, Col. Craig D. Shriver for his leadership, and the Henry M. Jackson Foundation for the Advancement of Military Medicine. We are grateful to the members and staff of the Army Regional Anesthesia and Pain Management Initiative, United States Military Cancer Institute, and the Clinical Breast Care Project for their consistent support of this collaborative research effort. Supported in part by the John P. Murtha Neuroscience and Pain Institute, the Clinical Breast Care Project, and the United States Military Cancer Institute.

Copyright Protection

Our team is composed partly of military service members and employees of the U.S. Government. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

DISCLAIMER

The views expressed in this presentation are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.

DISCLOSURE

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA

    Cletus A. Arciero MD

  2. Division of Surgical Oncology, Indiana University Health, Goshen Center for Cancer, Goshen, IN, USA

    Leonard R. Henry MD

  3. Department of Research Programs, Biostatistics Section, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Robin S. Howard MA

  4. Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA

    George E. Peoples MD

  5. United States Military Cancer Institute, Clinical Trials Group, Washington, DC, USA

    George E. Peoples MD, Anton J. Bilchik MD, PhD & Alexander Stojadinovic MD

  6. John Wayne Cancer Institute and California Oncology Research Institute, Santa Monica, CA, USA

    Anton J. Bilchik MD, PhD

  7. Bon Secours Cancer Institute, Richmond, VA, USA

    Itzhak Avital MD

  8. Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA

    Chester C. Buckenmaier III MD

  9. Department of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Alexander Stojadinovic MD

  10. Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Alexander Stojadinovic MD

Authors
  1. Cletus A. Arciero MD
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  2. Leonard R. Henry MD
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  3. Robin S. Howard MA
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  4. George E. Peoples MD
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  5. Anton J. Bilchik MD, PhD
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  6. Itzhak Avital MD
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  7. Chester C. Buckenmaier III MD
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  8. Alexander Stojadinovic MD
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Corresponding author

Correspondence to Alexander Stojadinovic MD.

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Arciero, C.A., Henry, L.R., Howard, R.S. et al. Technical Effects of Adding 1 % Lidocaine to Technetium Sulfur Colloid for Sentinel Lymphatic Mapping in Early Breast Cancer: Analysis of Data from a Double-blind Randomized Controlled Trial. Ann Surg Oncol 20, 2548–2555 (2013). https://doi.org/10.1245/s10434-013-2912-y

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  • DOI: https://doi.org/10.1245/s10434-013-2912-y

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