Abstract
Background/ObjectiveSPIO is effective in sentinel node (SN) detection. No nuclear medicine department is needed, and no allergic reactions have occurred. This study aimed to compare retro-areolar and peri-tumoral SPIO injections regarding skin staining, detection rates and number of SNs.MethodsData on staining size, intensity and cosmetic outcome (0–5; 0 = no problem) were collected by telephone interviews with 258 women undergoing breast conservation. SN detection and the number of SNs were prospectively registered in 332 women.ResultsAfter retro-areolar and peri-tumoral injections, 67.3% and 37.8% (p < 0.001) developed skin staining, with remaining staining in 46.2 vs. 9.4% after 36 months (p < 0.001). Initial mean size was 16.3 vs. 6.8 cm (p < 0.001) and after 36 months, 6.6 vs. 1.8 cm2 (p < 0.001). At 75.1% of 738 interviews, staining was reported paler. After retro-areolar injections, cosmetic outcome scored worse for 2 years. The mean (median) scores were 1.3(0) vs. 0.5(0) points, and 0.2(0) vs. 0.1(0) points, at 12 and 36 months, respectively. Overall detection rates were 98.3% and 97.4% (p = 0.43) and the number of SNs 1.35 vs. 1.57 (p = 0.02) after retro-areolar and peri-tumoral injections. Injection, regardless of type, 1–27 days before surgery increased detection rates with SPIO, 98.0% vs. 94.2% (p = 0.06) ,and SN numbers, 1.56 vs. 1.27 (p = 0.003).ConclusionSPIO is effective and facilitates planning for surgery. Peri-tumoral injection reduced staining with a similar detection rate. Staining was not considered a cosmetic problem among most women. Injecting SPIO 1–27 days before surgery increased the detection rate by 3.8% and increased the number of SNs by 0.3.
Highlights
Superparamagnetic iron oxide nanoparticles (SPIO) have comparable detection rates as the dual technique using Technetium[99] (Tc99) and Blue Dye (BD) for sentinel node (SN) detection.[1,2] SPIO has not been associated with allergic reactions and eliminates the need for nuclear medicine facilities, simplifying operative planning
Breast-conserving surgery was performed in 257 women (1 bilateral breast-conserving surgery (BCS))
Sentinel node identification using SPIO is comparable to TC99 and BD.[1,2]
Summary
Superparamagnetic iron oxide nanoparticles (SPIO) have comparable detection rates as the dual technique using Technetium[99] (Tc99) and Blue Dye (BD) for sentinel node (SN) detection.[1,2] SPIO has not been associated with allergic reactions and eliminates the need for nuclear medicine facilities, simplifying operative planning. As with BD, SPIO injection may cause skin staining for more than a year. This is seen almost exclusively after breast-conserving surgery (BCS). For BD, 41% of patients have been reported with staining after 12 months and up to 8.6% after 36 months.[4,5] To avoid skin staining, the injection technique was modified, and instead of injecting SPIO behind the areola, it was injected deeper, close to the tumour.[1]
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