title: A further validation of subareolar injection technique for breast sentinel lymph node biopsy.
abstract: BACKGROUND
  In this study we performed subdermal injection of (99m)Tc-labeled albumin combined with subareolar (SA) injection of blue dye, and we compared this technique with two techniques previously used in terms of the success of sentinel lymph node (SLN) identification, false-negative (FN) rate, and the overall accuracy and sensitivity of the three procedures. In all patients we performed a complete axillary lymph node dissection.
  
  
  METHODS
  From January 1999 to September 2004, a total of 195 patients with localized breast cancer were treated. Patients were subdivided into three groups. In patients in group 1 (n = 115; January 1999 to December 2001), lymphoscintigraphy together with injection of vital dye was performed; in group 2 (n = 40; January to October 2002), SA injection of blue dye alone was performed; and in group 3 (n = 40; November 2002 to September 2004), SA injection of blue dye and subdermal injection of radioisotope was performed.
  
  
  RESULTS
  The success rate of identifying an SLN by a combination of the two techniques was 95% in group 1 and 100% in group 3. The FN rate was 9% in group 1 and 0% in groups 2 and 3. The overall accuracy of lymphatic mapping was 97% in group 1 and 100% in groups 2 and 3. Sensitivity was 91% in group 1 and 100% in groups 2 and 3.
  
  
  CONCLUSIONS
  This study of SA injection for SLN biopsy using dual tracers demonstrates a high SLN identification rate and an absent FN rate. We propose that injection into the SA plexus is the optimal way to perform lymphatic mapping of the breast. This technique seems to be feasible even in patients with multicentric cancers.
authors.affiliation: Department of General and Special Surgery, University of Bari, Via S. Hahnemann, 2, Bari, 70126, Italy. gderedita@chirges.uniba.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Eredita
authors.forename: Carmela
authors.initials: C
authors.lastname: Giardina
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Guerrieri
authors.forename: Tommaso
authors.initials: T
authors.lastname: Berardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016009:Chi-Square Distribution; D004396:Coloring Agents; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007267:Injections; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D009558:Nipples; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid