Breast Oncology

Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2548-2555

First online:

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. ArcieroAffiliated withDepartment of Surgery, Dwight D. Eisenhower Army Medical Center
  • , Leonard R. HenryAffiliated withDivision of Surgical Oncology, Indiana University Health, Goshen Center for Cancer
  • , Robin S. HowardAffiliated withDepartment of Research Programs, Biostatistics Section, Walter Reed National Military Medical Center
  • , George E. PeoplesAffiliated withDepartment of Surgery, Brooke Army Medical CenterUnited States Military Cancer Institute, Clinical Trials Group
  • , Anton J. BilchikAffiliated withUnited States Military Cancer Institute, Clinical Trials GroupJohn Wayne Cancer Institute and California Oncology Research Institute
  • , Itzhak AvitalAffiliated withBon Secours Cancer Institute
  • , Chester C. Buckenmaier IIIAffiliated withDefense and Veterans Center for Integrative Pain Management
  • , Alexander StojadinovicAffiliated withUnited States Military Cancer Institute, Clinical Trials GroupDepartment of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical CenterUniformed Services University of the Health Sciences Email author 

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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.


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.


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).


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.