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Intradermal Radiocolloid and Intraparenchymal Blue Dye Injection Optimize Sentinel Node Identification in Breast Cancer Patients

Abstract

Background: Radiotracer and blue dye mapping of sentinel lymph nodes (SLN) have been advocated as accurate methods to stage the clinically negative axilla in breast cancer patients. The technical aspects of SLN biopsy are not fully characterized. In this study we compare the results of intraparenchymal (IP) and intradermal (ID) injection of Tc-99m sulfur colloid, to establish an optimal method for SLN localization.

Methods: 200 consecutive patients had SLN biopsy performed by a single surgeon. Of these, 100 (Group I) had IP injection and 100 (Group II) had ID injection of Tc-99m sulfur colloid. All patients had IP injection of blue dye as well. Endpoints included (1) successful SLN localization by lymphoscintigraphy, (2) successful SLN localization at surgery, and (3) blue dye–isotope concordance (uptake of dye and isotope by the same SLN).

Results: Isotope SLN localization was successful in 78% of Group I and 97% of group II patients (P < .001). When isotope was combined with blue dye, SLN were found in 92% of group I and 100% of Group II (P < .01). In cases where both dye and isotope were found in the axilla, dye mapped the same SLN as radiotracer in 97% of Group I and 95% of Group II patients.

Conclusions: The dermal and parenchymal lymphatics of the breast drain to the same SLN in most patients. Because ID injection is easier to perform and more effective, this technique may simplify and optimize SLN localization.

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REFERENCES

  1. Petrek JA, Blackwood MM. Axillary dissection: current practice and technique. Curr Probl Surg 1995;32:259–323.

    Google Scholar 

  2. Cabanas R. An approach for the treatment of penile carcinoma. Cancer 1977;39:456–466.

    CAS  PubMed  Google Scholar 

  3. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–399.

    CAS  PubMed  Google Scholar 

  4. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993;2:335–340.

    Article  CAS  PubMed  Google Scholar 

  5. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391–401.

    PubMed  Google Scholar 

  6. Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996;276:1818–1822.

    Article  CAS  PubMed  Google Scholar 

  7. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997;349:1864–1867.

    Article  CAS  PubMed  Google Scholar 

  8. Pijpers R, Hoekstra OS, Collet GJ, et al. Impact of lymphoscintigraphy on sentinel node identification with technetium-99mcolloidal albumin in breast cancer. J Nucl Med 1997;38:366–368.

    Google Scholar 

  9. Roumen RMH, Valkenburg JGM, Geuskens LM. Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer. Eur J Surg Oncol 1997;23:495–502.

    Google Scholar 

  10. Galimberti V, Zurrida S, Zucali P, Luini A. Can sentinel node biopsy avoid axillary dissection in clinically node-negative breast cancer patients? Breast 1998;7:8–10.

    Google Scholar 

  11. Borgstein PJ, Pijpers R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998;186:275–283.

    Article  CAS  PubMed  Google Scholar 

  12. Krag DN, Ashikaga T, Harlow SP, Weaver DL. Development of sentinel node targeting technique in breast cancer patients. Breast Journal 1998;4:67–74.

    Google Scholar 

  13. Offodile R, Hoh C, Barsky SH, et al. Minimally invasive breast cancer staging using lymphatic mapping with radiolabeled dextran. Cancer 1998;82:1704–1708.

    Google Scholar 

  14. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998;339:941–946.

    Article  CAS  PubMed  Google Scholar 

  15. Crossin JA, Johnson AC, Stewart PB, Turner WW. Gamma-probeguided resection of the sentinel lymph node in breast cancer. Am Surg 1998;64:666–669.

    Google Scholar 

  16. Snider H, Dowlatshahi K, Fan M, Bridger WM, Rayudu G, Oleske D. Sentinel node biopsy in the staging of breast cancer. Am J Surg 1998;176:305–310.

    Google Scholar 

  17. Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999;91:368–373.

    Article  CAS  PubMed  Google Scholar 

  18. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345–2350.

    Google Scholar 

  19. Guenther JM, Krishnamoorthy M, Tan LR. Sentinel lymphadenectomy for breast cancer in a community managed care setting. Cancer J Sci Am 1997;3:336–340.

    CAS  PubMed  Google Scholar 

  20. Flett MM, Going JJ, Stanton PD, Cooke TG. Sentinel node localization in patients with breast cancer. Br J Surg 1998;85:991–993.

    Google Scholar 

  21. Borgstein PJ, Meijer S, Pijpers R. Intradermal blue dye to identify sentinel lymph node in breast cancer. Lancet 1997;349:1668–1669.

    CAS  Google Scholar 

  22. O’Hea BJ, Hill ADK, El-Shirbiny A, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg 1998;186:423–427.

    Google Scholar 

  23. Barnwell JM, Arredondo MA, Kollmorgen D, et. al. Sentinel node biopsy in breast cancer. Ann Surg Oncol 1998;5:126–130.

    Google Scholar 

  24. Hill ADK, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528–535.

    Google Scholar 

  25. Linehan DC, Hill ADK, Tran KN, et al. Sentinel lymph node localization in breast cancer: unfiltered isotope is superior to filtered. J Am Coll Surg 1999;188:377–381.

    Google Scholar 

  26. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63:181–187.

    Google Scholar 

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Correspondence to Hiram S. Cody III MD.

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Linehan, D.C., Hill, A.D.K., Akhurst, T. et al. Intradermal Radiocolloid and Intraparenchymal Blue Dye Injection Optimize Sentinel Node Identification in Breast Cancer Patients. Ann Surg Oncol 6, 450–454 (1999). https://doi.org/10.1007/s10434-999-0450-4

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  • DOI: https://doi.org/10.1007/s10434-999-0450-4

Key Words

  • Breast cancer surgery
  • Sentinel node biopsy.