title: Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy.
abstract: BACKGROUND
  The optimal site for injection of mapping tracers is controversial in sentinel lymph node (SLN) biopsy for breast cancer. We evaluated whether a combination of peritumoral (PT) injection and subareolar (SA) injection can improve the identification rate of SLN biopsy and decrease the false-negative rate.
  
  
  METHODS
  Two hundred one patients underwent SLN biopsy with PT injection of radioisotope and SA injection of blue dye.
  
  
  RESULTS
  The overall identification rate for blue and/or hot lymph nodes was 99.5%; the identification rate of blue-dyed lymph nodes was 98.0% and that of hot lymph nodes was 97.0%. However, no concordance between the hot node and the blue node was found in 17 patients (8.5%). Among SLN-positive 51 patients, 4 patients had blue-only positive SLN and 7 had hot-only positive SLN. Consequently, the false-negative rates were at least 7.8% for PT injection and 13.7% for SA injection, while axillary lymph node dissection was not performed in SLN-negative patients. However, a combination of both injections significantly decreased the false-negative rate.
  
  
  CONCLUSIONS
  The success of SLN mapping is optimized not only by using dye and isotope in combination but also by using PT and SA injections in combination.
authors.affiliation: Department of Breast Oncology, Kanazawa University Hospital, Kanazawa, Japan. nogumasa@kanazawa-med.ac.jp
authors.forename: Masakuni
authors.initials: M
authors.lastname: Noguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Inokuchi
authors.forename: Yo
authors.initials: Y
authors.lastname: Zen
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007267:Injections; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D015609:Organotechnetium Compounds; C026177:technetium phytate; D010833:Phytic Acid