The value of combined peritumoral and subdermal injection techniques for lymphoscintigraphy in detection of sentinel lymph node in breast cancer.
OBJECTIVE
The aim of this study was to evaluate the success rate of combined peritumoral and subdermal injection techniques based on our previous experience on different injection techniques for lymphoscintigraphy.


METHODS
Fifty-nine women with early breast cancer (mean tumor size, 20.5 mm) were prospectively studied. On the morning of the operation, each patient had 2 injections, one peritumoral (PT) medial to the lesion and one subdermal (SD) into the skin over the tumor quadrant. Each injection consisted of 20 MBq (540 mCi) Tc-99m rhenium sulfide colloid. Early dynamic and delayed static images were obtained up to 4 hours after injections. An intraoperative gamma probe was used to explore the axillary sentinel lymph nodes (SLN). All surgical specimens were evaluated histopathologically.


RESULTS
Forty patients had breast-preserving surgery and 19 had modified radical mastectomy. Thirty-eight patients had axillary dissection. All but 4 patients showed axillary lymphatic drainage. Twelve of 59 patients (20%) showed extraaxillary drainage with lymphoscintigraphy. Combined injection technique yielded a 93.2% success rate in detecting axillary SLN. In 2 of 4 patients with no drainage on lymphoscintigraphy, intraoperative gamma probe revealed SLN during the surgery. Twenty patients (33%) had positive axillary lymph nodes. In 14 of them, the SLN was the only positive node. A false-negative rate was found 1.6% (one of 59 patients).


CONCLUSIONS
This results suggest that a combination of both PT and SD techniques increases the success rate of visualization SLN and enhances the visualization of extraaxillary nodes for further treatment planning.
Sanli
Yasemin
Y
Department of Nuclear Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. yaseminsanli75@yahoo.com
Berberoglu
Kezban
K
Turkmen
Cuneyt
C
Ozmen
Vahid
V
Muslumanoglu
Mahmut
M
Igci
Abdullah
A
Asoglu
Oktar
O
Kecer
Mustafa
M
Tuzlali
Sitki
S
Cantez
Sema
S
Mudun
Ayse
A
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D044584:Carcinoma, Ductal / Q000175:diagnosis* / Q000556:secondary*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007279:Injections, Subcutaneous; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage*
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid