不同示踪法在胃癌前哨淋巴结检测中的应用比较

目的 探讨理想的胃癌前哨淋巴结(SLN)检测方法.方法 前瞻性分析2004年1月至2008年8月广州军区广州总医院确诊的59例胃癌患者的临床资料,按随机数字表法将患者分为染料法组(20例)、核素法组(20例)和联合法组(19例),分别或联合注射专利蓝和99Tcm进行SLN检测.采用t检验和x2检验分析SLM的检出情况及SLN判断胃癌区域淋巴结转移的准确率和假阴性率.结果 染料法组共检出SLN 38枚,平均1.9枚/例;核素法组共检出SLN 31枚,平均1.6枚/例;联合法组共检出SLN56枚,平均2.9枚/例.联合法组中同时被染料和核素标记的SLN为46枚,单独被染料和核素标记的SLN分别为6枚和4枚.3组SLN检测数目比较,差异有统计学意义(t=4.35,P<0.05).其中联合法组SLN的检出数目明显多于染料法组和核素法组(t=4.21,3.54,P<0.05).染料法组、核素法组和联合法组诊断胃癌淋巴结转移的准确率和假阴性率分别为95%(19/20)和5%(1/20)、90%(18/20)和10%(2/20)、100%(19/19)和0,其中联合法组的准确率最高(x2=163.01,P<0.05),假阴性率最低(x2=170.14,P<0.05).结论 联合染料和核素标记物示踪法是检测胃癌SLN的理想方法.     

核素法导航乳腺癌前哨淋巴结不同部位注射的临床对比分析

目的探讨将示踪剂行乳晕下注射与肿瘤周围注射检测乳腺癌前哨淋巴结（SLN）的可行性及准确性。方法36例临床上腋窝淋巴结阴性的乳腺癌,术前18例患者于乳晕下注射1.0mCi的99mTc硫化胶体,另18例患者于肿瘤周围注射1.0mCi的99mTc硫化胶体,两组术中用手握式同位素探测仪确认有放射活性的SLN,行手术解剖出SLN,所取SLN单独送病检,相应腋窝行淋巴结清扫并常规病检。结果18例乳晕下注射发现SLN者17例,每例SLN平均数目为（1.3±0.7）枚,检出率为94.4%,SLN病检结果预测淋巴结的准确率为94.1%,假阴性1例,假阴性率为5.9%,18例肿瘤周围注射法的患者中发现SLN者16例,每例SLN平均为（2.1±0.9）枚,检出率为88.9%,SLN病检结果预测淋巴结的准确率为87.5%,2例假阴性,假阴性率为12.5%。结论核素法导航定位乳腺癌SLN能准确反映区域淋巴结的转移情况,同时乳晕下注射法比肿瘤周围注射法确定SLN有更高的准确性。     

在乳腺癌病人的前哨淋巴结活检中乳晕周围和肿瘤周围注射放射性示踪剂的比较

乳腺癌病人中前哨淋巴结 (SLN)活检的技术方法有多种 ,单放射性示踪剂的最佳注射部位尚无肯定的意见。为此 ,作者比较了乳晕周围和肿瘤周围注射示踪剂的结果。取日本 Osaka大学医学院肿瘤外科于 1997～ 2 0 0 0年收治的 15 5例 T1～ 2 期乳腺癌进行分析。在第一期试验 ,应用肿瘤周围注射蓝色染料共 6 2例 ,随后进行腋窝淋巴结清扫。在第二期试验 ,应用肿瘤周围注射蓝色染料和肿瘤周围注射 99m Tc(A组 4 1例 )或乳晕周围注射 99m Tc(B组 ,5 2例 )。结果　第一期试验、第二期 A组和 B组的病例特点大致相仿 ,但第一期试验的肿块较大些 (其…     

荧光法在乳腺癌前哨淋巴结活检中的应用价值

目的探讨荧光法在乳腺癌患者前哨淋巴结活检(SLNB)中的应用价值。方法前瞻性收集2014年5月至2015年2月期间甘肃省妇幼保健院收治的乳腺癌患者36例,通过于乳晕处皮内及皮下组织内注射吲哚菁绿(ICG)荧光示踪剂,动态引导定位寻找前哨淋巴结(SLN),分析ICG的示踪效果和SLNB对腋窝淋巴结转移状态的预测效果。结果 36例患者均成功行SLNB,SLN检出率为100%;共检出SLN 86枚,1~3枚/例,平均2.39枚/例;从皮肤切开至取出SLN的手术时间为3~22 min,平均9 min。术中冰冻病理学检查示16例有SLN癌转移,20例无SLN癌转移;1例术中冰冻病理学检查示无SLN癌转移者,术后石蜡切片病理学检查示有SLN癌转移。ICG示踪下SLNB的灵敏度为94.1%(16/17),假阴性率为5.9%(1/17)。结论荧光法动态引导定位用于乳腺癌SLNB,具有定位准确、检出率高及创伤小的优势,能较准确地预测乳腺癌患者腋窝淋巴结的状态。     

影响染料法乳腺癌前哨淋巴结活检成功率的一些因素

目的探讨影响染料法乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)成功率的因素及其可能机制.方法172例T1、T2乳腺癌病人,其中术前腋窝触及肿大淋巴结者16例.全身麻醉后,采用1%异硫蓝5 ml或美蓝4 ml,随机注入乳晕或肿瘤周围后行SLNB;然后作根治术或改良根治术,并将全部标本送病理学检查.比较病人年龄、腋窝淋巴结肿大、术前活检、肿瘤大小、组织类型、染料、注射部位、训练曲线等因素对SLNB检出率的影响.结果在术前触及腋窝淋巴结肿大的16例中,前哨淋巴结(sentinel lymph node,SLN)的检出率明显低于未触及者(x2=18355,P=0.000),而假阴性率则明显增高(X2=12.205,P=0.000).位于外上象限的肿瘤SLNB前行切除活检,SLN的检出率显著降低(x2=5.690,P=0.017).前30例SLN的检出率明显低于后142例(X2=5.807,P=0.016)病人的年龄、肿瘤位置、肿瘤大小、组织类型、染料以及注射部位等因素对SLNB成功率影响不大(P＞0.05).结论术前腋窝淋巴结肿大及SLNB前行外上象限肿瘤切除活检可明显影响SLNB的成功率,其原因可能与乳腺至腋窝之间的淋巴引流途径改变有关.通过训练可提高SLN的检出率.     

乳晕下与肿瘤周围注射示踪剂定位乳腺癌前哨淋巴结的Meta分析

目的:比较乳晕下与肿瘤周围注射示踪剂定位乳腺癌前哨淋巴结(SLN)的检出率与准确性。方法:检索国内外数据库收集关于乳晕下及肿瘤周围注射示踪剂定位乳腺癌对比研究的文献,提取数据后,用Metadisc 1.4软件进行统计学分析。结果:最终纳入7项研究,共1 350例患者,其中乳晕下注射总共794例,检出SLN 747例,检出率为94.08%,肿瘤周围注射总共556例,检出SLN 506例,检出率为91.01%,前者检出率明显高于后者(P=0.031)。乳晕下与肿瘤周围注射示踪剂定位前哨淋巴结合并后的灵敏度分别为0.962(95%CI=0.929~0.983)、0.937(95%CI=0.890~0.968);特异性为1.000(95%CI=0.988~1.000)、1.000(95%CI=0.988~1.000);SROC曲线下面积分别为0.983 3、0.956 3。结论:在确定乳腺癌SLN方面,乳晕下注射法检出率高于肿瘤周围注射法,但两种方法的准确性均较高。     

亚甲蓝示踪乳腺癌前哨淋巴结活检的临床可行性

目的:探讨亚甲蓝染料定位法检测乳腺癌前哨淋巴结（SLN）的临床价值。方法:对65例腋窝淋巴结临床检查阴性的乳腺癌患者在行乳腺癌根治性手术前用0.5％亚甲蓝4 mL注射定位，单独活检SLN；同时行常规腋窝淋巴结清扫术，根据注射部位，将入组患者分为乳晕注射组(34例)和肿块旁注射组(31例)，其中对两组的检出结果进行比较。结果:58例患者SLN成功检出，检出率为89.22%（58/65），假阴性率为8.33％(1/12)。乳晕周围注射组的检出率为85.29%(29/34)，假阴性率为20.0%(1/5)；肿块周围腺体内注射组检出率为93.55%(29/31)，无假阴性病例。两组的检出率和假阴性率比较结果均无统计学差异（P＞0.05）;15例出现SLN和非SLN均蓝染，其中乳晕周围注射组11例，发生率为37.93%(11/34)，肿块周围腺体内注射组4例，发生率为13.79%(4/31),两者比较差异有显著性(P＜0.05)。结论:亚甲蓝是一种安全、可靠的乳腺癌SLN示踪剂；肿块周围腺体内注射SLN定位较乳晕注射准确。     

亚甲蓝染色法前哨淋巴结活检在乳腺癌手术中的应用分析(附66例报告)

目的总结亚甲蓝染色法前哨淋巴结活检在乳腺癌手术中应用时亚甲蓝注射的适宜剂量、注射后的等待时间及前哨淋巴结的定位及追踪经验。方法 66例乳腺癌病人,以1%亚甲蓝注射剂为示踪剂,肿瘤位于外上象限者,则注射于肿瘤表面皮下,若肿瘤位于其他部位,则注射于乳晕或者外上象限皮下。九分法定位切取前哨淋巴结。结果 66例患者施行保乳手术17例,改良根治术49例,均成功检出前哨淋巴结,共检出前哨淋巴结210枚,平均每例3.2枚(1~8枚),成功率为100%。结论选择亚甲蓝剂量为2ml,根据肿瘤位置选择注射位置,皮下弥漫浸润注射,注射后按摩5min,等待5min,九分法定位行前哨淋巴结活检成功率高。     

99Tcm-硫化铼胶体在乳腺癌前哨淋巴结活检中的应用

目的：探讨99Tcm-硫化铼胶体在乳腺癌前哨淋巴结（SLN）活检中的应用价值。 方法：30例T1~T2期乳腺恶性肿瘤患者入选,术前15~24 h乳晕下注射99Tcm-硫化铼,使用SPECT/CT进行SLN淋巴显像,定位;术中用γ探测仪寻找SLN,行SLN活检后,常规行乳癌手术;术后对SLN活检和腋窝淋巴结（ALN）清扫的病理结果进行比较分析。 结果：30例共有29例检到SLN,共检出SLN 31枚,检出率,准确率分别为97.67%,100%;SLN状态与腋淋巴结转移的符合率为100%,无假阳性及假阴性情况出现。 结论：99Tcm-硫化铼用于乳腺癌SLN活检是一种较理想的核素示踪剂。     

吲哚氰绿荧光显影联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检中的效果对比

目的探讨吲哚氰绿(ICG)联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检(SLNB)中的效果差异。方法回顾性收集2017年6月到2019年2月期间于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗后行SLNB并同时行腋窝淋巴结清扫(ALND)的乳腺癌患者77例,其中通过ICG+亚甲蓝示踪行SLNB的乳腺癌患者46例(ICG+亚甲蓝组),通过核素+亚甲蓝示踪行SLNB的乳腺癌患者31例(核素+亚甲蓝组)。比较2组患者的示踪效果。结果 77例患者中至少检出1枚前哨淋巴结(SLN)者73例,SLN检出率为94.80%,其中ICG+亚甲蓝组43例,核素+亚甲蓝组30例。ICG+亚甲蓝组患者的NAC后前哨淋巴结检出率为93.48%(43/46),平均检出SLN 2.32枚/例,灵敏度为82.61%(19/23),假阴性率为17.39%(4/23),准确率为90.70%(39/43)。核素+亚甲蓝组的SLN检出率为96.77%(30/31),平均检出SLN 2.6枚/例,灵敏度为83.33%(10/12),假阴性率为16.67%(2/12),准确率为93.33%(28/30)。2组的SLN检出率、检出数目、灵敏度、假阴性率及准确率比较差异均无统计学意义(P0.05)。结论 ICG联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后的乳腺癌SLNB中具有相似的SLN检出率、SLN检出数目、灵敏度、准确率及假阴性率,可以推广实施。     

Sentinel Lymph Node Biopsy for Melanoma: How Many Radioactive Nodes Should be Removed?

Background: Sentinel lymph node (SLN) biopsy has become a standard method of staging patients with cutaneous melanoma. Sentinel lymph node biopsy usually is performed by intradermal injection of a vital blue dye (isosulfan blue) plus radioactive colloid (technetium sulfur colloid) around the site of the tumor. Intraoperative gamma probe detection has been shown to improve the rate of SLN identification compared to the use of blue dye alone. However, multiple sentinel nodes often are detected using the gamma probe. It is not clear whether these additional lymph nodes represent true sentinel nodes, or second-echelon lymph nodes that have received radiocolloid particles that have passed through the true sentinel node. This analysis was performed to determine the frequency with which these less radioactive lymph nodes contain metastatic disease when the most radioactive, or hottest, node does not.Materials and Methods: In the Sunbelt Melanoma Trial, 1184 patients with cutaneous melanoma of Breslow thickness 1.0 mm or more had sentinel lymph nodes identified. Sentinel lymph node biopsy was performed by injection of technetium sulfur colloid plus isosulfan blue dye in 99% of cases. Intraoperative determination of the degree of radioactivity of sentinel nodes (ex vivo) was measured, as well as the degree of blue dye staining.Results:Sentinel nodes were identified in 1373 nodal basins in 1184 patients. A total of 288 of 1184 patients (24.3%) were found to have sentinel node metastases detected by histology or immunohistochemistry. Nodal metastases were detected in 306 nodal basins in these 288 patients. There were 175 nodal basins from 170 patients in which at least one positive sentinel node was found and more than one sentinel node was harvested. Blue dye staining was found in 86.3% of the histologically positive sentinel nodes and 66.4% of the negative sentinel nodes. In 40 of 306 positive nodal basins (13.1%), the most radioactive sentinel node was negative for tumor when another, less radioactive, sentinel node was positive for tumor. In 20 of 40 cases inding a positive sentinel node other than the hottest node.Conclusions: If only the most radioactive sentinel node in each basin had been removed, 13.1% of the nodal basins with positive sentinel nodes would have been missed. It is recommended that all blue lymph nodes and all nodes that measure 10% or higher of the ex vivo radioactive count of the hottest sentinel node should be harvested for optimal detection of nodal metastases.Preliminary findings presented at the annual meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Improved Lymphatic Mapping Technique for Breast Cancer

Abstract: Breast sentinel lymph node biopsy is becoming more common. However, the best injection technique is not well established. Currently the gold standard is peritumoral injection. However, for upper outer quadrant tumors there is considerable axillary “shine through” which makes the identification of the radioactive sentinel lymph node difficult. We undertook a study to compare an injection in Sappey's subareolar plexus to the gold standard of peritumoral injection. Between December 1997 and March 1998, 85 patients with breast cancer were enrolled in the study. All patients were injected with 2 cc of normal saline containing 1.0 mCi of unfiltered technetium sulfur colloid in Sappey's subareolar plexus in the clock position of the breast cancer. In the operating room the patients underwent a peritumoral injection of 5 cc of 1% isosulfan blue. All blue and radioactive lymph nodes were identified and removed. The majority of the tumors were in the upper outer quadrant and were diagnosed by core biopsy. Only half of the patients had palpable tumors and approximately 25% had previous upper outer quadrant biopsy incisions. Peritumoral blue dye injection yielded an identification rate of 94%, with 99% of these being blue and radioactive. Three patients had radioactive lymph nodes with no blue lymph nodes identified. One of these patients had a micrometastasis. Injection in Sappey's subareolar plexus in the clock position of the tumor drained to the same sentinel lymph node as peritumoral injection. This injection technique solved the two major problems confronting the wide adoption of sentinel lymph node biopsy for breast cancer staging. First, it eliminates axillary “shine through” which will allow nonspecialist surgeons to more easily identify the radioactive axillary sentinel lymph node. Second, it allows for easier isotope injection by the technician or nuclear medicine physician, by eliminating the need for three-dimensional localization. This new technique should allow the majority of breast cancer patients who are treated by nonspecialist surgeons to be offered this less morbid, more accurate procedure.     

Sentinel node imaging and biopsy in breast cancer patients.

BACKGROUND: Several techniques have been shown to be accurate in identifying axillary sentinel lymph nodes. The accuracy of subareolar blue dye injection is compared with intraparenchymal radioisotope injection. METHODS: Forty-two consecutive patients with breast cancer were injected with both intraparenchymal technetium-99m and subareolar isosulfan blue dye. After sentinel lymph node identification, an axillary lymph node dissection was performed. RESULTS: The blue dye and the technetium-99m localized to the same axillary nodes even though the injection sites were different. The sensitivity of blue dye in identifying axillary sentinel nodes was 100%. The sensitivity of radioisotope injection in identifying sentinel nodes was 97.6%. CONCLUSIONS: Subareolar blue dye injection is an extremely accurate and cost-effective method of sentinel node identification in breast cancer patients.     

A New Radiocolloid for Sentinel Node Detection in Breast Cancer

Background:The optimal radioactive tracer and technique for sentinel lymph node localization in breast cancer is yet to be determined. The dilemma of small particle size with dispersion to second echelon nodes versus failure of migration of larger radiocolloids needs to be resolved. A new radiocolloid preparation with particle size under 0.1 micron was developed with excellent primary/post lymphatic entrapment ratio.Objective:To assess the feasibility of a new ^99mTc radiocolloid cysteine-rhenium colloid in sentinel lymph node (SLN) localization for breast cancer.Methods:Forty-seven patients with newly diagnosed T1 or T2 breast cancer underwent injection of ^99mTc-labeled cysteine-rhenium colloid followed by lymphoscintigraphy. Same day SLN biopsy with patent blue dye and intraoperative gamma probe to identify SLNs were performed.Results:SLN mapping and intraoperative localization were successful in 46/47 (98%) of patients. The blue dye radioactive tracer concordance was 94%. There was one false-negative in a patient with a nonpalpable tumor that underwent ultrasound-guided peritumoral radiocolloid injection.Conclusions:^99mTc-cysteine-rhenium colloid is highly effective in identifying SLNs. It has the advantage of smaller particle size than sulfur colloid with easier lymphatic migration. It has a more neutral pH with less pain on injection and does not require filtration, thereby minimizing radiation exposure to technologists.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16–19, 2000     

Chirurgie de la thyroid

Background: We evaluated the concordance between peri-areolar blue dye and peri-incisional radiotracer injections for axillary sentinel node mapping of patients with the history of previous breast lesion excisional biopsy. Methods: 80 patients with the history of previous excisional biopsy of the breast lesions were included. All patients received two injections of 99mTc-antimony sulfide colloid in both ends of incision line in an intradermal fashion. 2 mL patient blue V dye was injection to all patients in the peri-areolar area of the index quadrant after induction of anesthesia. All blue or hot nodes were harvested as sentinel lymph nodes.

Results: At least one sentinel node could be detected during surgery in 79 patients. In total 94 sentinel nodes were detected. All detected sentinel nodes were hot. In three patients sentinel nodes were detected by gamma probe but not blue dye. The tumor location in all of these patients was in the upper lateral quadrant and the incision line was extended into the axillary tail of the breast in all of them. 91 out of 94 sentinel nodes were stained blue, which amounts to 95.8% concordance between blue dye and radiotracer on a per node analysis.

Conclusions: Single peri-areolar injection in the index quadrant would suffice for sentinel node mapping of patients with history of excisional biopsy. Care should be taken in patients with large excisional biopsy in the extreme proximity to axilla.     

Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation

PURPOSE: We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with penile cancer and no palpable inguinal adenopathy. MATERIALS AND METHODS: The records of 31 patients with invasive penile cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with (99m)technetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status. RESULTS: Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for cancer detection was 86%. Using dynamic sentinel node biopsy with blue dye plus radiotracer 5 sentinel lymph nodes were positive for cancer, although 2 false-negative results were obtained. Thus, the sensitivity of dynamic sentinel node biopsy per groin for cancer detection was 71%. CONCLUSIONS: In our experience preoperative lymphoscintigraphy and dynamic sentinel node biopsy as currently performed remain insufficient for detecting occult inguinal disease. Superficial lymph node dissection remains the gold standard for detecting inguinal microscopic metastasis in select patients.     

Radiolabeled Sentinel Node Biopsy: Collaborative Trial with the National Cancer Institute

The objective of this study was to maximize the success rate of sentinel node (SN) localization in breast cancer patients with the tracer that demonstrated the highest initial success during a preliminary evaluation. Altogether, 145 patients with operable invasive breast cancer and clinically negative lymph nodes were studied. Technetium 99m (99mTc)-sulfur colloid was injected into the breast parenchyma surrounding the invasive cancer or the biopsy cavity. Variable volumes of tracer, amounts of 99mTc, and duration of time between injection and surgery were evaluated. A hand-held gamma detector was used at surgery to locate and guide resection of all radioactive sentinel nodes (SNs), including those that were extraaxillary. A conventional lymphadenectomy was then performed in all cases. Based on previous studies, unfiltered sulfur colloid provided a higher success rate of SN identification than the other tracer types. Further evaluation with 99mTc-sulfur colloid demonstrated that increased volume increased the success rate of SN identification. An injection volume of 8 ml resulted in a success rate of 98%. SNs were not exclusively located in the axilla: In 8.6% of cases SNs were removed from an internal mammary location. The overall accuracy of patients with SNs resected was 98.4%, and the false-negative rate was 4.4%. It was concluded that (1) unfiltered 99mTc-sulfur colloid at a volume of 8 ml resulted in a high success rate for SN identification; (2) a significant number of the SNs were extraaxillary in location; and (3) the accuracy of the SNs for determining whether regional metastases had occurred was high. The U.S. National Cancer Institute is funding a randomized phase III clinical trial to evaluate SN resection compared to conventional axillary lymphadenectomy in clinical node-negative breast cancer patients. Major endpoints of this trial include long-term regional control and survival.     

Comparison of intradermal and subcutaneous injections in lymphatic mapping

BACKGROUND: Sentinel node biopsy (SNB) for melanoma, with its intradermal (ID) injection, has a higher success rate than SNB for breast cancer, which is typically performed with a subcutaneous (SC) or peritumor injection. It is hypothesized that this is in part due to a slower transit time of lymphatic mapping agents through the parenchymal lymphatics of the breast. No study has investigated differences in transit time between different tissues to account for this clinical observation. The goal of the study was to compare transit time between ID and SC injections with common agents used in lymphatic mapping. METHODS: Four injection sites on five domestic pigs were used. Sites were bilateral and included cervical, forelimb, hindlimb, and flank areas. Agents included technetium sulfur colloid (Tc99, filtered and unfiltered), isosulfan blue (IB) dye, and fluorescein (FL) dye. At each site both ID and SC injections were made and the transit time to reach the sentinel node was recorded. The transit time differences were calculated per centimeter distance from the draining lymph node basin. RESULTS: Sentinel nodes were identified draining all sites and found to be hot, blue, or fluorescent (using a Wood's lamp for identification). The cervical and forelimb injection sites drained to the same cervical lymph node basin and both SC and ID injection sites drained to the same sentinel node. Similarly, the hindlimb and flank injection sites both drained to inguinal lymph node basins. The slowest transit time occurred with Tc99 injected SC and the fastest occurred with Tc99 injected ID, whereas both FL dye and IB traveled rapidly to the sentinel node whether injected SC or ID. Large differences were found using unfiltered Tc99 depending on its injection ID (2.7 s/cm +/- 0.5) vs SC (249 s/cm +/- 14.7, P = 0.008). CONCLUSIONS: Tc99 ID injections were significantly faster than SC injection. The slowest and fastest SC injection agents were unfiltered Tc99 and IB, respectively. Dermal injections provide faster transit of lymphatic agents and may improve the identification rate when applied to patients with breast cancer.     

Lymphoscintigraphy does not enhance sentinel node identification or alter management of patients with early breast cancer

SUMMARY: Lymphoscintigraphy (LS) is often performed before sentinel lymph node dissection (SLND) for breast cancer. The purpose of this study was to determine whether routine LS enhances rate of identification of sentinel nodes (SN), and if findings on LS alter either the SLND procedure or the subsequent patient management. METHODS: LS using technetium-99m sulfur colloid (99mTc) was performed in 136 consecutive patients undergoing SLND for invasive breast cancer. Three equal aliquots of 99mTc were injected peritumorally, and LS images were obtained at 60 to 120 min after 99mTc injection. Data were collected on the success of LS to visualize SN. Information regarding body mass index (BMI), biopsy type (core vs excisional), tumor location (medial vs lateral), and SN positivity were recorded and comparison was made with success of operative SN identification. In all SLND cases, 1% lymphazurin blue dye was used in addition to the 99mTc. RESULTS: LS failed to identify an SN in 9 of 136 cases (6.6%). Failed mappings did not correlate with biopsy type, tumor location, or SN positivity. There was a positive correlation between increased BMI and failed LS (p = <0.001). Failed LS did not predict operative SLND failure, as an SN was identified in 100% of cases (136/136), including the 9 with a failed LS. In 67% (6/9) of the failed LS, the SN was both hot and blue at operation. Internal mammary (IM) drainage was observed in 4% (6/136) of LS. Positive SN were found in 26% (35/136) of patients. Findings on LS did not affect adjuvant treatment decisions in any patient. CONCLUSIONS: There was a correlation between failed LS and BMI, but no correlation with biopsy type or tumor location. Drainage to extraaxillary sites was rare. LS findings did not enhance success of intraoperative identification of SN or alter the postoperative management of patients with early stage breast cancer.