title: Immediate preoperative injection of 99m-Tc sulfur colloid is effective in the detection of breast sentinel lymph nodes.
abstract: Sentinel lymph node (SLN) biopsy is an accurate technique to determine the metastatic status of lymph nodes. Radionuclide guidance makes the procedure easier and improves the success rate. Coordinating the operating room and nuclear medicine schedules causes delays when same-day radionuclide injection is used. We hypothesized that injection of 99m-Tc sulfur colloid immediately preoperatively is effective in SLN detection. We analyzed a prospective database of 70 patients treated at Harbor-UCLA Medical Center. The first 39 patients underwent completion axillary dissection (Group A) and subdermal injection of sulfur colloid immediately before surgery. A second group of 31 patients (Group B) had intraparenchymal injection immediately before surgery. We used isosulfan blue in all cases. SLNs were identified in 97 per cent of cases. SLNs were radioactive in 94 per cent and blue in 90 per cent. In Group A the accuracy and the positive and negative predictive values of SLN biopsy were 100 per cent. SLN counts per second ranged from 22 to 1700. The mean count per second was 290 +/- 281 (mean +/- standard deviation). Subdermal and intraparenchymal injections were equally successful (93% vs 92%). In conclusion injection of radiocolloid and isosulfan blue immediately preoperatively is highly successful and accurate in the detection of SLNs in breast cancer. It avoids operating room schedule delays.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
authors.forename: Hernan I
authors.initials: HI
authors.lastname: Vargas
authors.forename: Maria P
authors.initials: MP
authors.lastname: Vargas
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Gonzalez
authors.forename: Melissa
authors.initials: M
authors.lastname: Burla
authors.forename: Rose
authors.initials: R
authors.lastname: Venegas
authors.forename: Linda
authors.initials: L
authors.lastname: Diggles
authors.forename: Fred
authors.initials: F
authors.lastname: Mishkin
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Klein
authors.forename: Iraj
authors.initials: I
authors.lastname: Khalkhali
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007267:Injections; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid; D013997:Time Factors
chemical_list: D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid