Abstract
Background. The technique of sentinel lymph node (SLN) biopsy in patients with breast cancer
varies among reports, and the optimal method remains to be established, particularly
with regard to the site of radiotracer injection. The aim of this study was to compare
periareolar and peritumoral injection of radiotracer in detecting SLN in patients
with breast cancer. Methods. Patients with T1-2 breast cancer (n = 155) were enrolled in this study. In phase
1 (n = 62), SLN biopsy was performed by using peritumoral injection of blue dye alone
followed by backup axillary lymph node dissection. In phase 2, SLN biopsy was performed
by using peritumoral injection of blue dye and peritumoral (group A, n = 41) or periareolar
(group B, n = 52) injection of technetium 99m tin colloid. Results. In phase 1, the detection rate of SLN was 81% and the false-negative rate was 5.6%,
indicating our skill in SLN biopsy. In phase 2, the success rate of lymphoscintigraphy
was significantly (P <.001) higher in group B (90%) than in group A (51%). The mean ex vivo radioactivity
of SLN in group B (117 counts per second; range, 5 to 900) was also significantly
(P <.05) higher than in group A (51 counts per second; range, 8 to 260). In addition,
the detection rate of SLN was significantly (P <.05) higher in group B (100%) than in group A (90%). Conclusions. Periareolar injection of radiotracer for SLN biopsy is superior to peritumoral injection
because of its simplicity, achieving a high success rate in lymphoscintigraphy and
SLN detection. (Surgery 2002;131:277-86.)
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References
- An approach for the treatment of penile carcinoma.Cancer. 1977; 39: 456-466
- Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg. 1992; 127: 392-399
- Lymphatic mapping and sentinel lymphadenectomy for breast cancer.Ann Surg. 1994; 220: 391-401
- Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe.Surg Oncol. 1993; 2: 335-340
- Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.JAMA. 1996; 276: 1818-1822
- The sentinel node in breast cancer: a multicenter validation study.N Engl J Med. 1998; 339: 941-946
- Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer.Ann Surg. 1998; 227: 645-653
- Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.Lancet. 1997; 349: 1864-1867
- Meta-analysis of sentinel lymph node biopsy in breast cancer.J Surg Res. 1999; 84: 138-142
- Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used.J Clin Oncol. 2000; 18: 2560-2566
- Sentinel lymph node mapping and biopsy for breast cancer: a review of the literature relative to 4791 procedures.Tumori. 1999; 85: 425-434
- Subareolar versus peritumoral injection for location of the sentinel lymph node.Ann Surg. 1999; 229: 860-865
- Subareolar injection of 99m-Tc sulfur colloid for sentinel nodes identification in multifocal invasive breast cancer [in French].Bull Cancer. 1999; 86: 939-945
- Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye.J Am Coll Surg. 1999; 189: 539-545
- Preoperative lymphoscintigraphy during lymphatic mapping for breast cancer: improved sentinel node imaging using subareolar injection of technetium 99m sulfur colloid.J Am Coll Surg. 2000; 191: 479-489
- Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method.Ann Surg. 2000; 232: 81-89
- Mapping a pathway for axillary staging: a personal perspective on the current status of sentinel lymph node dissection for breast cancer.Arch Surg. 1999; 134: 195-199
- Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer.J Clin Oncol. 2000; 18: 2553-2559
- Implementation of new surgical technology: outcome measures for lymphatic mapping of breast carcinoma.Ann Surg Oncol. 1999; 6: 553-561
- Intraoperative lymphatic mapping and sentinel lymphadenectomy: community standard care or clinical investigation?.Cancer J Sci Am. 1997; 3: 328-330
- Sentinel-lymph-node biopsy for breast cancer: not yet the standard of care.N Engl J Med. 1998; 339: 990-995
- The surgical significance of the subareolar lymph plexus in cancer of the breast.Surgery. 1953; 33: 71-78
- Lymphatic drainage of the breast demonstrated by vital dye staining and radiography.Ann Surg. 1965; 162: 221-226
- Lessons learned from 500 cases of lymphatic mapping for breast cancer.Ann Surg. 1999; 229: 528-535
- Quantitative lymphoscintigraphy I: basic concepts for optimal uptake of radiocolloids in the parasternal lymph nodes of rabbits.J Nucl Med. 1979; 20: 1038-1046
- Mammary lymphoscintigraphy in breast cancer.J Nucl Med. 1995; 36: 1775-1780
- Gamma probe guided sentinel node biopsy in breast cancer.Q J Nucl Med. 1997; 41: 251-261
- Optimized sentinel node scintigraphy in breast cancer.Q J Nucl Med. 1998; 42: 49-53
- Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients.Ann Surg Oncol. 1999; 6: 450-454
- Mammary lymphoscintigraphy with various radiopharmaceuticals in breast cancer.Ann Nucl Med. 1999; 13: 325-329
- Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection.J Am Coll Surg. 1998; 186: 275-283
- Lymphatic mapping with intralesional tracer administration in breast carcinoma patients.Cancer. 2000; 88: 2546-2552
- Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series.J Natl Cancer Inst. 1999; 91: 368-373
- Sentinel node localization by lymphoscintigraphy: a reliable technique with widespread applications.Recent Results Cancer Res. 2000; 157: 121-129
- Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer.J Nucl Med. 1997; 38: 366-368
- The implementation of the sentinel node biopsy as a routine procedure for patients with breast cancer.Surgery. 2000; 128: 6-12
Article info
Publication history
Accepted:
October 28,
2001
Footnotes
*Supported in part by a Grant-in-aid for Science Research from the Ministry of Education, Sports, Science, and Technology of Japan.
**Reprint requests: Shinzaburo Noguchi, MD, Department of Surgical Oncology, Osaka University Medical School, 2-2-E10 Yamada-oka, Suita, Osaka 565-0871, Japan.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.