Abstract
BackgroundSentinel lymph node biopsy after technetium-99 (Tc99) localization is a mainstay of oncologic breast surgery. The timing of Tc99 injection can complicate operating room schedules, which can cause increasing overall costs of care and patient discomfort.MethodsThis study compared 59 patients who underwent breast cancer surgery including sentinel lymph node biopsy. Based on the surgeon’s choice, 29 patients were treated with Tc99, and 30 patients received the iron-based tracer, Magtrace. The primary outcomes were time spent on the care pathway and operating time from commissioning of the probe to removal of the sentinel node. The secondary outcomes were patient pain levels and reimbursement.ResultsThe mean time spent on the preoperative breast cancer care pathway was significantly shorter for the Magtrace group (5.4 ± 1.3 min) than for the Tc99 group (82 ± 20 min) (p < 0.0001). The median time from probe usage to sentinel node extirpation was slightly but not significantly shorter in the Magtrace group (5 min; interquartile range [IQR], 3–15 min vs 10 min; IQR, 7–15 min; p = 0.151). Reimbursement and pain levels remained unchanged, and the hospital length of stay was similar in the two groups (Magtrace: 5.1 ± 2.3 days vs Tc99: 4.5 ± 3.2 days).ConclusionsMagtrace localization shortened the preoperative care pathway and did not affect surgical time or reimbursement. Once established, it could allow for cost reduction and improve patient comfort.
Highlights
Sentinel lymph node biopsy after technetium-99 (Tc99) localization is a mainstay of oncologic breast surgery
The exclusion criteria ruled out patients younger than 40 years, BRCA1/2 mutation, breast composition level C or higher according to the fifth edition of the American College of Radiology Breast Imaging-Reporting and Data System (ACR BI-RADS),[19] high likelihood of a breast magnetic resonance imaging (MRI) in the 5 years, hypersensitivity to iron oxide or dextran compounds, hemochromatosis, and metal implants in the axilla or chest
A significant difference was shown concerning the estrogen-receptor expression, with 100% of the tumors estrogen receptorpositive in the Magtrace group compared with only 73.9% of the tumors estrogen receptor-positive in the control group (p = 0.007)
Summary
Sentinel lymph node biopsy after technetium-99 (Tc99) localization is a mainstay of oncologic breast surgery. The timing of Tc99 injection can complicate operating room schedules, which can cause increasing overall costs of care and patient discomfort. This study compared 59 patients who underwent breast cancer surgery including sentinel lymph node biopsy. The primary outcomes were time spent on the care pathway and operating time from commissioning of the probe to removal of the sentinel node. The mean time spent on the preoperative breast cancer care pathway was significantly shorter for the Magtrace group (5.4 ± 1.3 min) than for the Tc99 group (82 ± 20 min) (p \ 0.0001). The median time from probe usage to sentinel node extirpation was slightly but not significantly shorter in the Magtrace group
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