Experience with intradermal injection and intradermal-plus-deep injection in the radioguided sentinel node biopsy of early breast cancer patients.
OBJECTIVE
Methods of administering (99m)Tc-phytate during sentinel node biopsy of early breast cancer patients were compared to improve the sensitivity of the technique.


METHODS
Two injection methods, intradermal vs. intradermal-plus-deep injection, were compared in 648 early breast cancer patients. Intradermal injection was done in 323 consecutive patients (325 breasts), and intradermal-plus-deep injection was done in 325 consecutive patients (329 breasts). The following items were compared: (1) The number of axillary nodes detected scintigraphically and removed surgically, and the breast number of micrometastasis to axillary nodes; (2) The number of internal mammary nodes detected scintigraphically and removed surgically; and (3) The sensitivity of axillary SNB.


RESULTS
The number of axillary nodes scintigraphically detected was 1.63+/-0.80 (mean+/-SD) in patients given intradermal injection, and was 1.82+/-0.94 in patients given intradermal-plus-deep injection. The number of axillary nodes surgically removed was 1.78+/-0.93 in patients given intradermal injection, and was 1.95+/-0.99 in patients given intradermal-plus-deep injection. The visualization of internal mammary nodes was superior with intradermal-plus-deep injection (5/325 for intradermal, and 51/329 for intradermal-plus-deep). The putative sensitivity was 71/72 (98.6%) for the intradermal-plus-deep method and 56/62 (90.3%) for the intradermal method. The frequency of detection of micrometastasis was 24 in 71 true positive (38.8%) for the intradermal-plus-deep method and 13 in 56 true positive (23.2%) for the intradermal method.


CONCLUSIONS
The SNB procedure with the intradermal-plus-deep injection method detected more axillary and internal mammary nodes, more (not statistically significant) micrometastasis and improved the putative sensitivity more than the SNB procedure with the intradermal injection method.
Koizumi
M
M
Department of Nuclear Medicine, Cancer Institute Hospital, Ariake 3-10-6, Koto-ku, Tokyo 135-8550, Japan. mitsuru@jfcr.or.jp
Koyama
M
M
Yamashita
T
T
Tada
K-I
KI
Nishimura
S-I
SI
Takahashi
K
K
Makita
M
M
Iwase
T
T
Yoshimoto
M
M
Kasumi
F
F
D001365:Axilla; D001940:Breast; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015609:Organotechnetium Compounds / Q000008:administration & dosage*; D010833:Phytic Acid / Q000008:administration & dosage*; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C026177:technetium phytate; D010833:Phytic Acid