Abstract
Background. Most institutions require a patient undergoing sentinel lymph node biopsy to go through nuclear medicine prior to surgery to be injected with radioisotope. This study describes the long-term results using intraoperative injection of radioisotope. Methods. Since late 2002, all patients undergoing a sentinel lymph node biopsy at the Yale-New Haven Breast Center underwent intraoperative injection of technetium-99m sulfur colloid. Endpoints included number of sentinel and nonsentinel lymph nodes obtained and number of positive sentinel and nonsentinel lymph nodes. Results. At least one sentinel lymph node was obtained in 2,333 out of 2,338 cases of sentinel node biopsy for an identification rate of 99.8%. The median number of sentinel nodes found was 2 and the mean was 2.33 (range: 1–15). There were 512 cases (21.9%) in which a sentinel node was positive for metastatic carcinoma. Of the patients with a positive sentinel lymph node who underwent axillary dissection, there were 242 cases (54.2%) with no additional positive nonsentinel lymph nodes. Advantages of intraoperative injection included increased comfort for the patient and simplification of scheduling. There were no radiation related complications. Conclusion. Intraoperative injection of technetium-99m sulfur colloid is convenient, effective, safe, and comfortable for the patient.
Highlights
Sentinel lymph node biopsy has replaced axillary dissection for axillary staging in clinically node negative breast cancer patients [1]
When the procedure was first developed in the 1990s, radioisotope was injected into the peritumoral area of the breast and lymphoscintigraphy was performed to evaluate lymphatic drainage into the sentinel nodes over the hour or two
It was found that routine lymphoscintigraphy was not necessary as accurate identification of sentinel nodes was possible without the preoperative images [7]
Summary
Sentinel lymph node biopsy has replaced axillary dissection for axillary staging in clinically node negative breast cancer patients [1]. It was found that routine lymphoscintigraphy was not necessary as accurate identification of sentinel nodes was possible without the preoperative images [7] This made intraoperative injection a feasible approach and several small series reported excellent results [8,9,10]. Despite clear advantages to intraoperative injection, many institutions still require patients to go through nuclear medicine for injection prior to surgery. Most institutions require a patient undergoing sentinel lymph node biopsy to go through nuclear medicine prior to surgery to be injected with radioisotope. Since late 2002, all patients undergoing a sentinel lymph node biopsy at the Yale-New Haven Breast Center underwent intraoperative injection of technetium-99m sulfur colloid. Intraoperative injection of technetium-99m sulfur colloid is convenient, effective, safe, and comfortable for the patient
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