Standard versus pH-adjusted and lidocaine supplemented radiocolloid for patients undergoing sentinel-lymph-node mapping and biopsy for early breast cancer (PASSION-P trial): a double-blind, randomised controlled trial

Stojadinovic, Alexander; Peoples, George E.; Jurgens, Jennifer; Howard, Robin S.; Schuyler, Brandi; Kwon, Kyung H.; Henry, Leonard R.; Shriver, Craig D.; Buckenmaier, Chester C.

doi:10.1016/s1470-2045(09)70194-9

Cited by 26 publications

(20 citation statements)

References 13 publications

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“…Investigators used this method in a randomized, double-blind trial, where pain was compared between patients that received the standard Tc 99m SC injection or a pH-adjusted and lidocaine supplemented formula [11]. A total of 140 participants were randomly assigned equally to four groups, to receive 4 % topical lidocaine cream and the Tc 99m SC injection, or to one of the three other groups: to receive topical placebo cream and Tc 99m SC with either sodium bicarbonate, 1 % lidocaine, or sodium bicarbonate and 1 % lidocaine.…”

Section: Discussionmentioning

confidence: 99%

“…A significant reduction in pain scores was observed in the groups where Tc 99m SC included 1 % lidocaine. The addition of 1 % lidocaine added to the radioisotope solution can help to eliminate some of the pain experienced during this injection [11]. …”

Section: Discussionmentioning

confidence: 99%

“…In the operating room, the sentinel lymph nodes are identified using a hand-held gamma probe which detects lymph nodes that uptake the radiotracer [7–9]. SNL is the preferred standard approach for axillary staging in women with early breast cancer; however, the subareolar Tc 99m SC injection is associated with significant transient pain [9–11]. …”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of sentinel node identification is maintained with the addition of local lidocaine and subareolar radioactive colloid injection

Stearns

Blackford

Kessler

et al. 2015

Breast Cancer Res Treat

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Preoperative sentinel node localization (SNL) using a subareolar injection of radiotracer technetium-99m-sulfur colloid (Tc99mSC) is associated with significant pain. Lidocaine use during SNL is not widely adopted partly due to a concern that it can obscure sentinel node identification and reduce its diagnostic accuracy. We prospectively identified women with a biopsy-proven infiltrating breast cancer who were awaiting a SNL. The women completed the McGill pain questionnaire, Visual Analog Scale, and Wong–Baker FACES Pain Rating Scale prior to and following SNL. We identified a retrospective cohort of women with similar demographic and tumor characteristics who did not receive lidocaine before SNL. We compared sentinel lymph node identification rates in the two cohorts. We used Wilcoxon rank sum tests to compare continuous measures and Fisher's exact test for categorical measures. Between January 2011 to July 2012, 110 women consented, and 105 were eligible for and received lidocaine prior to Tc99mSC injection. The post-lidocaine identification rate of SNL was 95 % with Tc99mSC, and 100 % with the addition of intraoperative methylene blue dye/saline. Pain range prior to and following the SNL was unchanged (P = 0.703). We identified 187 women from 2005 to 2009 who did not receive lidocaine during preoperative SNL. There was no significant difference in the success rate of SNL, with or without lidocaine (P = 0.194). The administration of lidocaine during SNL prevents pain related to isotope injection while maintaining the success rate. We have changed our practice at our center to incorporate the use of lidocaine during all SNL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of sentinel node identification is maintained with the addition of local lidocaine and subareolar radioactive colloid injection

Stearns

Blackford

Kessler

et al. 2015

Breast Cancer Res Treat

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“…In regards to buffering the SC before injection, Stokes et al and Stojadinovic et al separately concluded that mixing lidocaine or lidocaine with sodium bicarbonate with the SC reduced pain when compared with placebo and topical anesthetic, without significantly altering the detection of sentinel lymph nodes (5,6). However, altering the SC solution before injection has the potential to change the SC particle size, pH, and possibly the particle aggregation and kinetics through the lymphatics.…”

Section: Discussionmentioning

confidence: 99%

Administration of Subcutaneous Buffered Lidocaine Prior to Breast Lymphoscintigraphy Reduces Pain Without Decreasing Lymph Node Visualization

Hawkins

Yoo

Movson

et al. 2014

Journal of Nuclear Medicine Technology

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and 2 Alaska Radiology Associates, Anchorage, AlaskaBreast lymphoscintigraphy using 99m Tc-sulfur colloid ( 99m Tc-SC) is well established in clinical practice for staging patients with breast carcinoma. Nearly all patients report having pain during the procedure. However, techniques used to minimize pain during breast lymphoscintigraphy are highly variable across institutions. Our study was to determine whether anesthetizing the skin with sodium bicarbonatehether-buffered lidocaine before performing breast lymphoscintigraphy reduced the pain experienced by the patients. The second objective of this study was to evaluate whether anesthetizing the skin with buffered lidocaine changed visualization of lymph nodes. Methods: This prospective, patient-masked and randomized study involved performing breast lymphoscintigraphy in a control group and experimental group of female breast cancer patients. The control group did not receive skin anesthetic before 99m Tc-SC injections, whereas the experimental group first underwent skin anesthesia with an injection of 2% sodium bicarbonate-buffered lidocaine. All patients were asked to rate their pain levels, using the National Institutes of Health pain scale, before the procedure and immediately after the injections. The change in pain from baseline was compared between the 2 groups. After the injections, scintigraphic imaging of the axilla was performed, and the number of axillary lymph nodes visualized was recorded. Results: No significant difference was found in preprocedural baseline pain from the control group, compared with the experimental group. There was a statistically significant difference in the increase in pain experienced during the procedure between the control group and the experimental group (P 5 0.009). There was no significant difference in the detection of lymph nodes between the control and experimental groups (P 5 0.56). Conclusion: The results from our study indicate that injecting subcutaneous buffered lidocaine before intradermal injection of 99m Tc-SC for breast lymphoscintigraphy significantly decreases patient pain without interfering with lymph node visualization.

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“…Krynyckyi et al [32] reported a reduction in subjective experience of pain with the use of topical anesthetic cream. A randomized trial at the Walter Reed Army Medical Center of women undergoing intradermal injection of radiocolloid for sentinel node biopsy demonstrated reduction in mean pain scores with the addition of 1% lidocaine to the technetium-99m colloid injection solution compared to use of topical anesthetic cream alone [33]. Adjusting the pH of the lidocaine with bicarbonate did not impair sentinel node detection, but also did not significantly alleviate pain.…”

Section: Radioisotopementioning

confidence: 99%

Tracer agents for the detection of sentinel lymph nodes in breast cancer: Current concerns and directions for the future

Kelley

Holmes

2011

Journal of Surgical Oncology

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Standard versus pH-adjusted and lidocaine supplemented radiocolloid for patients undergoing sentinel-lymph-node mapping and biopsy for early breast cancer (PASSION-P trial): a double-blind, randomised controlled trial

Cited by 26 publications

References 13 publications

Diagnostic accuracy of sentinel node identification is maintained with the addition of local lidocaine and subareolar radioactive colloid injection

Diagnostic accuracy of sentinel node identification is maintained with the addition of local lidocaine and subareolar radioactive colloid injection

Administration of Subcutaneous Buffered Lidocaine Prior to Breast Lymphoscintigraphy Reduces Pain Without Decreasing Lymph Node Visualization

Tracer agents for the detection of sentinel lymph nodes in breast cancer: Current concerns and directions for the future

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