title: Combination of subareolar blue dye and peritumoral RI for sentinel lymph node biopsy.
abstract: BACKGROUND
  The identification rate of sentinel lymph nodes (SLNs) is variable because numerous different methods employing different tracers have been used for sentinel lymph node detection. The aim of this study was to determine the optimal technique for sentinel lymph node biopsy (SLNB).
  
  
  METHODS
  From May 1999 to December 2001, SLNB was performed for 376 patients with T1-3 and N0-1 primary breast cancer using blue dye alone, radioisotope (RI) alone and combination of RI and blue dye. Two hundred sixty-eight patients underwent SLNB using blue dye alone. They were divided into 4 groups (Group A: n=50; peritumoral injection, Group B: n=83; the first half to receive subareolar injection, Group C: n=83; the second half to receive subareolar injection, and Group D: n=52; small incision according to an axillary skin landmark). One hundred eight patients underwent SLNB using RI. Tin colloid was used in 49 cases (Tin Colloid Group) and phytate in 59 cases (Phytate Group). Among them, 29 patients underwent injection of RI alone and 79 patients received a combination of RI and blue dye.
  
  
  RESULTS
  The identification rates of SLN using blue dye alone were 60%, 82%, 92% and 79% in Groups A, B, C and D, respectively. The identification rates of SLN in patients receiving RI alone and in those receiving combination of RI and blue dye were 40% and 89%, respectively, in Tin Colloid Group, and 92% and 94%, respectively, in Phytate Group.
  
  
  CONCLUSIONS
  When using blue dye alone, subareolar injection provided a better identification rate than peritumoral injection. The combination of peritumoral phytate and subareolar blue dye provided the best identification rate (94%) in all the groups. The combination of intraparenchymal phytate and subareolar blue dye was the most efficient technique for sentinel node biopsy in breast cancer patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya 466-8550, Japan. nobtsun@med.nagoya-u.ac.jp
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tsunoda
authors.forename: Hiroji
authors.initials: H
authors.lastname: Iwata
authors.forename: Shuhei
authors.initials: S
authors.lastname: Sarumaru
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Mizutani
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwase
authors.forename: Shigeto
authors.initials: S
authors.lastname: Miura
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D004396:Coloring Agents; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008197:Lymph Node Excision; D009558:Nipples; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D017556:Technetium Compounds; D017971:Tin Compounds
chemical_list: D004396:Coloring Agents; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid; C026177:technetium phytate; D010833:Phytic Acid