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

Linehan, David C.; Hill, A. D. K.; Akhurst, Timothy; Yeung, Henry; Yeh, Samuel D. J.; Tran, Katherine N.; Borgen, Patrick I.; Cody, Hiram S.

doi:10.1007/s10434-999-0450-4

Cited by 221 publications

(110 citation statements)

References 24 publications

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“…The intradermal method [4,5,14] is extremely convenient, is less stressful for the patient, generates higher SLN uptake, and produces less scatter from the injection site. Given the propensity for many surgeons to use an intradermal approach, we conducted this study to ensure that Lymphoseek was compatible with this technique.…”

Section: Discussionmentioning

confidence: 99%

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Sentinel lymph node mapping of breast cancer via intradermal administration of Lymphoseek

Wallace

Hoh

Darrah

et al. 2007

Nuclear Medicine and Biology

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Lymphoseek™ is a molecular imaging agent specifically designed for sentinel lymph node (SLN) mapping. We conducted a Phase I trial which measured the injection site clearance and sentinel lymph node accumulation after a single intra-dermal injection of Lymphoseek or [ 99m Tc]sulfur colloid protocol. Ten patients with breast cancer participated in this study. Five patients received an intradermal administration of 1.0 nmole of 99m Tc-labeled Lymphoseek and five patients received an intra-dermal administration of filtered [ 99m Tc]sulfur colloid (fTcSC). Lymphoseek, exhibited a significantly (P < .001) faster injection site clearance than fTcSC. The mean Lymphoseek clearance half-time was 2.61 ± 0.72 hr compared to 24.1 ± 17.7 hr for fTcSC. The mean sentinel lymph node uptake of Lymphoseek (1.1 ± .5%), and TcSC (2.5 ± 4.9%) were statistically equivalent (P = 0.28). When an intra-dermal injection was employed, Lymphoseek demonstrated faster injection site clearance than filtered [ 99m Tc]sulfur colloid.

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Section: Discussionmentioning

confidence: 99%

“…Each patient received a single injection (0.1 ml) of either Lymphoseek (1 nmole) or filtered [ 99m Tc]sulfur colloid above the lesion using an intradermal technique [4,5]. The administration site was massaged for several minutes.…”

Section: Nuclear Imagingmentioning

confidence: 99%

Sentinel lymph node mapping of breast cancer via intradermal administration of Lymphoseek

Wallace

Hoh

Darrah

et al. 2007

Nuclear Medicine and Biology

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“…Various injection techniques have been described, 2,[11][12][13] and it is not clear whether one is optimal. These techniques include peritumoral injection, subdermal injection, and injection of Sappey's plexus.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Trial of Sentinel Node Biopsy for Breast Cancer Using Both Technetium Sulfur Colloid and Isosulfan Blue Dye

et al. 2001

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ObjectiveTo determine the factors associated with false-negative results on sentinel node biopsy and sentinel node localization (identification rate) in patients with breast cancer enrolled in a multicenter trial using a combination technique of isosulfan blue with technetium sulfur colloid (Tc99). Summary Background DataSentinel node biopsy is a diagnostic test used to detect breast cancer metastases. To test the reliability of this method, a complete lymph node dissection must be performed to determine the false-negative rate. Single-institution series have reported excellent results, although one multicenter trial reported a false-negative rate as high as 29% using radioisotope alone. A multicenter trial was initiated to test combined use of Tc99 and isosulfan blue. MethodsInvestigators (both private-practice and academic surgeons) were recruited after attending a course on the technique of sentinel node biopsy. No investigator participated in a learning trial before entering patients. Tc99 and isosulfan blue were injected into the peritumoral region. ResultsFive hundred twenty-nine patients underwent 535 sentinel node biopsy procedures for an overall identification rate in finding a sentinel node of 87% and a false-negative rate of 13%. The identification rate increased and the false-negative rate decreased to 90% and 4.3%, respectively, after investigators had performed more than 30 cases. Univariate analysis of tumor showed the poorest success rate with older patients and inexperienced surgeons. Multivariate analysis identified both age and experience as independent predictors of failure. However, with older patients, inexperienced surgeons, and patients with five or more metastatic axillary nodes, the falsenegative rate was consistently greater. ConclusionsThis multicenter trial, from both private practice and academic institutions, is an excellent indicator of the general utility of sentinel node biopsy. It establishes the factors that play an important role (patient age, surgical experience, tumor location) and those that are irrelevant (prior surgery, tumor size, Tc99 timing). This widens the applicability of the technique and identifies factors that require further investigation.Since the description of sentinel lymph node biopsy (SNB) in the early 1990s, results for breast cancer have been reported in several single-institution series.1-4 These results were promising, and the sentinel node predicted the presence or absence of disease in the remaining axillary lymph

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“…It is uncertain which of these two routes is favoured by cells metastasising to the axilla [5][6][7][8][9][10][11][12][13][14][15]. Only when this has been established will the evidence be in place to guide the ideal injection site for axillary comparison between different tissue plane injections at different times in the same subject using the same radiotracer [14,15].…”

Section: Introductionmentioning

confidence: 99%

A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

Fowler

Solanki

Guenther

et al. 2009

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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

Abstract: 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.

Cited by 221 publications

References 24 publications

Sentinel lymph node mapping of breast cancer via intradermal administration of Lymphoseek

Sentinel lymph node mapping of breast cancer via intradermal administration of Lymphoseek

Multicenter Trial of Sentinel Node Biopsy for Breast Cancer Using Both Technetium Sulfur Colloid and Isosulfan Blue Dye

A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

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