Effectiveness of immediate preoperative injection of radiopharmaceutical and blue dye for sentinel node biopsy in patients with breast cancer

Abstract

Background Sentinel node biopsy (SNB) in breast cancer conventionally utilises a preoperative radioisotope injection and lymphoscintigraphy, which is time consuming and painful. The aim of this study was to evaluate a potentially more efficient and practical technique of immediate preoperative injection of blue dye and radiopharmaceutical by the surgeon (without involvement of a nuclear medicine department). Method One hundred and sixty three clinically node negative patients with invasive breast cancer undergoing breast-conserving surgery were included. The radiopharmaceutical was delivered to the operating suite and injected by the surgeon in the subareolar region immediately after induction of anaesthesia. Sentinel node biopsy was performed in conjunction with removal of any palpable axillary lymph nodes (axillary node sampling). Results Sentinel nodes (SNs) were detected in 161 of 163 women. On average, 3.0 sentinel nodes were identified. Twenty nine patients had involved nodes of whom 28 had a positive sentinel node. Of the two patients with failed identification, one had involved axillary lymph nodes on sampling and the other had an involved intramammary lymph node. Conclusion This method produces results identical to those obtained with other techniques. This study shows that sentinel node biopsy can be performed safely without involvement of a nuclear medicine department with the added benefits of no preoperative injection and improved efficiency in the operating suite.