title: Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients.
abstract: BACKGROUND
  Radiotracer and blue dye mapping of sentinel lymph nodes (SLN) have been advocated as accurate methods to stage the clinically negative axilla in breast cancer patients. The technical aspects of SLN biopsy are not fully characterized. In this study we compare the results of intraparenchymal (IP) and intradermal (ID) injection of Tc-99m sulfur colloid, to establish an optimal method for SLN localization.
  
  
  METHODS
  200 consecutive patients had SLN biopsy performed by a single surgeon. Of these, 100 (Group I) had IP injection and 100 (Group II) had ID injection of Tc-99m sulfur colloid. All patients had IP injection of blue dye as well. Endpoints included (1) successful SLN localization by lymphoscintigraphy, (2) successful SLN localization at surgery, and (3) blue dye-isotope concordance (uptake of dye and isotope by the same SLN).
  
  
  RESULTS
  Isotope SLN localization was successful in 78% of Group I and 97% of group II patients (P < .001). When isotope was combined with blue dye, SLN were found in 92% of group I and 100% of Group II (P < .01). In cases where both dye and isotope were found in the axilla, dye mapped the same SLN as radiotracer in 97% of Group I and 95% of Group II patients.
  
  
  CONCLUSIONS
  The dermal and parenchymal lymphatics of the breast drain to the same SLN in most patients. Because ID injection is easier to perform and more effective, this technique may simplify and optimize SLN localization.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Linehan
authors.forename: A D
authors.initials: AD
authors.lastname: Hill
authors.forename: T
authors.initials: T
authors.lastname: Akhurst
authors.forename: H
authors.initials: H
authors.lastname: Yeung
authors.forename: S D
authors.initials: SD
authors.lastname: Yeh
authors.forename: K N
authors.initials: KN
authors.lastname: Tran
authors.forename: P I
authors.initials: PI
authors.lastname: Borgen
authors.forename: H S
authors.initials: HS
authors.lastname: Cody
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D004396:Coloring Agents / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007279:Injections, Subcutaneous; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage
chemical_list: D004396:Coloring Agents; D013671:Technetium Tc 99m Sulfur Colloid