Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer

Additional Tracer Injection to Improve the Technical Success Rate of Lymphoscintigraphy for Sentinel Node Biopsy in Breast Cancer

“…2 The lymphatic mapping procedure consists of 370 MBq (10 mCi) TC-99 m-nanocolloid injected peritumorally or in the breast parenchyma surrounding the cavity of a previous excisional biopsy. All patients underwent preoperative lymphoscintigraphy following a mean interval of 16 h (range 12-18 h).…”

“…2 In 2002 preoperative ultrasonography of the axilla was introduced in our hospital and became standard procedure in combination with fine-needle aspiration (FNA) cytology in case of clinically or radiologically suspicious axillary lymph nodes. Thus, patients treated before 2002 did not receive routine ultrasound investigation of the axilla.…”

“…2,[9][10][11][12][13][14] This can be explained by nodal tracer uptake physiology: the radioactive tracer is bound to colloid, which is phagocytosed by macrophages within the normal lymph tissue of the SN. If the SN, or the afferent lymph tracts, show massive tumor infiltration and/ or extranodal growth, the lymph flow might be blocked, or Lymphatic tumor burden does not seem to affect blue dye uptake because, in contrast to the uptake of radiocolloid, which is based on sufficient functional lymph tissue, blue dye uptake is a process of passive diffusion through the lymphatic system.…”

“…20,21 Lymph nodes that can be palpated intraoperatively through the incision of the SN biopsy and are felt to be suspicious should be harvested and regarded as SN. 2,22,23 Axillary Ultrasound…”

“…[1][2][3][4][5][6] As compared with axillary lymph node dissection (ALND), SN biopsy causes less morbidity and provides the same staging information. As a consequence, ALND is nowadays abandoned in case of a negative SN biopsy, thereby avoiding unnecessary morbidity and costs associated with ALND.…”