title: Utility of breast sentinel lymph node biopsy using day-before-surgery injection of high-dose 99mTc-labeled sulfur colloid.
abstract: BACKGROUND
  In sentinel lymph node (SLN) biopsy for breast cancer, many centers use same-day preoperative injection of technetium 99mTc-labeled sulfur colloid and intraoperative injection of blue dye for localization of SLNs. Same-day sulfur colloid injections can be problematic because of the variability in sulfur colloid migration times, which can lead to ineffective use of operating room time, and low SLN-to-background radioactivity ratios. We examined the utility of day-before-surgery injections of high dose 99mTc-labeled sulfur colloid injections.
  
  
  METHODS
  The day before surgery, high-dose 99mTc-labeled sulfur colloid was injected peritumorally, and a lymphoscintigram was obtained. Intraoperatively, after injection of blue dye, a gamma probe was used to localize SLNs. Nodes that were stained blue or were highly radioactive were considered SLNs and were removed.
  
  
  RESULTS
  Lymphoscintigraphy demonstrated drainage in 107 patients (91%). Transcutaneous localization of the SLN was possible in 104 patients (89%). In three patients, all of whom had no drainage demonstrated on lymphoscintigraphy, no SLN was identified at surgery (97.5% success rate for SLN identification). A mean of 2.3 SLNs per patient were identified. Twenty-five patients (21%) had at least one histologically positive SLN. In 23 of these patients, the positive SLN was the SLN with the most radioactivity, and in the remaining two patients, the positive SLN was both blue-stained and hot.
  
  
  CONCLUSIONS
  Day-before-surgery injection of high-dose 99mTc-labeled sulfur colloid results in high rates of transcutaneous and intraoperative identification of SLNs. The delay between injection and surgery did not appear to promote significant passage of sulfur colloid to second-echelon nodes.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Solorzano
authors.forename: M I
authors.initials: MI
authors.lastname: Ross
authors.forename: E
authors.initials: E
authors.lastname: Delpassand
authors.forename: N
authors.initials: N
authors.lastname: Mirza
authors.forename: J S
authors.initials: JS
authors.lastname: Akins
authors.forename: H M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: F
authors.initials: F
authors.lastname: Meric
authors.forename: F C
authors.initials: FC
authors.lastname: Ames
authors.forename: L
authors.initials: L
authors.lastname: Newman
authors.forename: B
authors.initials: B
authors.lastname: Feig
authors.forename: S E
authors.initials: SE
authors.lastname: Singletary
authors.forename: K K
authors.initials: KK
authors.lastname: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008220:Lymphography / Q000379:methods*; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid