title: The use of periareolar intradermal Tc-99m tin colloid and peritumoral intraparenchymal isosulfan blue dye injections for determination of the sentinel lymph node.
abstract: OBJECTIVE
  The purpose of the present study was to evaluate the use of lymphoscintigraphy, blue dye, and gamma probe detection methods for determination of the sentinel lymph node (SLN) using both periareolar intradermal injection of Tc-99m tin colloid and peritumoral intraparenchymal injection of isosulfan blue dye.
  
  
  METHODS
  One hundred patients with T1-2 breast cancer and clinically negative nodes were enrolled in the present study. The study was composed of 2 groups. Backup axillary lymph node dissection (ALND) was mandatory in group 1 (20 patients) regardless of their lymph node status. In group 2 (80 patients), complete ALND was performed when intraoperative frozen section analysis of SLN revealed metastases. Otherwise, only SLN biopsy was performed without ALND. One day before surgery, Tc-99m tin colloid was injected at 4 periareolar sites intradermally. Lymphoscintigraphy was performed 1 to 2 hours after injection of the radiocolloid. Twenty minutes before surgery, isosulfan blue dye was injected into parenchyma surrounding the tumor or the biopsy cavity.
  
  
  RESULTS
  The detection rates of SLN and false-negative rate of lymphoscintigraphy, blue dye, and gamma probe detection were 85%, 95% 100%, and 0% in group 1, 91%, 87%, and 95% in group 2, respectively. Detection rate by the combination of blue dye and radio tracer was 98%.
  
  
  CONCLUSIONS
  According to the results of our study, we conclude that perioareolar intradermal injection of Tc-99m tin colloid combined with peritumoral intraparenchymal injection of blue dye is an accurate and easy method of locating the sentinel node with very high detection rates. It is recommended that the combination of all methods such as lymphoscintigraphy, blue dye, and gamma probe application will increase the success rate of SLN detection in patients with breast cancer.
authors.affiliation: Department of Nuclear Medicine, Ege University Medical Faculty, Izmir, Turkey. muratargon@gmail.com
authors.forename: Aziz Murat
authors.initials: AM
authors.lastname: Argon
authors.forename: Ulkem
authors.initials: U
authors.lastname: Duygun
authors.forename: Ebru
authors.initials: E
authors.lastname: Acar
authors.forename: Gozde
authors.initials: G
authors.lastname: Daglioz
authors.forename: Levent
authors.initials: L
authors.lastname: Yenjay
authors.forename: Ozman
authors.initials: O
authors.lastname: Zekioglu
authors.forename: Murat
authors.initials: M
authors.lastname: Kapkac
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012394:Rosaniline Dyes / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D017556:Technetium Compounds; D017971:Tin Compounds
chemical_list: D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid; C025484:iso-sulfan blue