title: Subareolar injection of 99mTc facilitates sentinel lymph node identification.
abstract: BACKGROUND
  Sentinel lymph node (SLN) biopsy with the standard intraparenchymal injection has been accepted as an alternative to routine axillary dissection for patients with breast cancer. However, the identification and false-negative rates with this method can vary widely from surgeon to surgeon. The subareolar location contains a rich lymphatic network and represents a potential site of injection for SLN identification.
  
  
  METHODS
  Between August 1, 1999, and December 31, 2000, we performed 159 SLN biopsy procedures on 158 patients with breast cancer. For each patient, 99mTc-labeled sulfur colloid was injected into the subareolar location, and 1% isosulfan blue dye was given as an intraparenchymal injection.
  
  
  RESULTS
  In every case, at least one radioactive SLN was identified with the subareolar injection of technetium; a blue SLN was found in 97% of the cases. The blue SLN was also radioactive in 98% of the cases, indicating that the blue dye injected around the tumor and the technetium injected into the subareolar location drained to the same SLN.
  
  
  CONCLUSIONS
  Subareolar injection of technetium can improve SLN identification rates for breast cancer. The simplicity and accuracy of this technique may also reduce the variable results reported with the standard intraparenchymal method.
authors.affiliation: Department of Surgery, Park Nicollet Clinic, Minneapolis, Minnesota, USA. tutt1006@umn.edu
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
authors.forename: Marybeth
authors.initials: M
authors.lastname: Colbert
authors.forename: Robert
authors.initials: R
authors.lastname: Christensen
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Ose
authors.forename: Thomas
authors.initials: T
authors.lastname: Jones
authors.forename: Robert
authors.initials: R
authors.lastname: Wetherille
authors.forename: Joel
authors.initials: J
authors.lastname: Friedman
authors.forename: Karen
authors.initials: K
authors.lastname: Swenson
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008207:Lymphatic Metastasis; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012394:Rosaniline Dyes / Q000008:administration & dosage; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid