title: A second radioisotope injection enhances intraoperative sentinel node identification in breast cancer patients without visualized nodes on preoperative lymphoscintigraphy.
abstract: OBJECTIVE
  To evaluate the influence of a second radioisotope injection on the intraoperative success rate in patients with non-visualized axillary sentinel nodes (SN).
  
  
  METHODS
  Altogether, 534 consecutive breast cancer patients with lymphoscintigraphy (LS) and SN biopsy and were included. An intratumoral injection of 99mTc-labeled human albumin colloid with a median dose of 93 MBq was applied. Forty-two of the 80 patients without axillary hot spots on LS received a second tracer injection with a median dose of 70 MBq.
  
  
  RESULTS
  The visualization rate of axillary SN was 454/534 (85%). The intraoperative SN identification rate was 97% in patients with and 69% in patients without visualized SN in the axilla (P<0.00005), but the success rate was higher (88%) with a second radioisotope injection than without it (47%; P<0.0002).
  
  
  CONCLUSIONS
  The failure rate in intraoperative SN identification was minimized using a second radioisotope injection in patients without axillary SN on LS.
authors.affiliation: Breast Surgery Unit, Maria Hospital, Helsinki, Finland. junny.leikola@hus.fi
authors.forename: J P
authors.initials: JP
authors.lastname: Leikola
authors.forename: E A
authors.initials: EA
authors.lastname: Leppänen
authors.forename: K A J
authors.initials: KA
authors.lastname: von Smitten
authors.forename: M H K
authors.initials: MH
authors.lastname: Leidenius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011877:Radionuclide Imaging; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid