Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2548–2555

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

  • Cletus A. Arciero
  • Leonard R. Henry
  • Robin S. Howard
  • George E. Peoples
  • Anton J. Bilchik
  • Itzhak Avital
  • Chester C. Buckenmaier III
  • Alexander Stojadinovic
Breast Oncology

DOI: 10.1245/s10434-013-2912-y

Cite this article as:
Arciero, C.A., Henry, L.R., Howard, R.S. et al. Ann Surg Oncol (2013) 20: 2548. doi:10.1245/s10434-013-2912-y

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.

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Cletus A. Arciero
    • 1
  • Leonard R. Henry
    • 2
  • Robin S. Howard
    • 3
  • George E. Peoples
    • 4
    • 5
  • Anton J. Bilchik
    • 5
    • 6
  • Itzhak Avital
    • 7
  • Chester C. Buckenmaier III
    • 8
  • Alexander Stojadinovic
    • 5
    • 9
    • 10
  1. 1.Department of SurgeryDwight D. Eisenhower Army Medical CenterFort GordonUSA
  2. 2.Division of Surgical OncologyIndiana University Health, Goshen Center for CancerGoshenUSA
  3. 3.Department of Research ProgramsBiostatistics Section, Walter Reed National Military Medical CenterBethesdaUSA
  4. 4.Department of SurgeryBrooke Army Medical CenterFort Sam HoustonUSA
  5. 5.United States Military Cancer InstituteClinical Trials GroupWashingtonUSA
  6. 6.John Wayne Cancer Institute and California Oncology Research InstituteSanta MonicaUSA
  7. 7.Bon Secours Cancer InstituteRichmondUSA
  8. 8.Defense and Veterans Center for Integrative Pain ManagementRockvilleUSA
  9. 9.Department of Surgery, Division of Surgical OncologyWalter Reed National Military Medical CenterBethesdaUSA
  10. 10.Uniformed Services University of the Health SciencesBethesdaUSA