title: Sentinel node imaging in breast cancer using superficial injections: technical details and observations.
abstract: BACKGROUND
  Sentinel lymph node (SLN) biopsy is the evolving standard of care for the management of early breast cancer. Accurate identification of the SLN is paramount for success of this procedure. Various techniques are described for SLN identification, but the superficial injection techniques, advocated by the UK National Training Programme (NEW START), are validated, reproducible and rapid. Pre-operative lymphoscintigraphy provides a road map for the surgeon and requires a reporting template.
  
  
  METHODS
  As one of the NEW START training institutions in the UK practising this technique, we reviewed a mature series of 100 unselected, consecutive SLN lymphoscintigraphy procedures. We correlated the imaging, operative and pathology findings and have provided technical details of the technique and a template for reporting SLN lymphoscintigrams.
  
  
  RESULTS
  The SLN localisation rate was 99% with one failed imaging. Seven patients required delayed imaging. The mean activity of the radiocolloid injected was 14.4MBq (range 8.3-23 MBq). The SLNs were visualised in the ipsilateral axilla in 98 images, intramammary in 3, and internal mammary in 1. A mean of 1.35 nodes were classified as 'True' SLNs on imaging criteria. Intra-operatively, a mean of 1.91 SLNs were excised. 32 of 116 hot and blue nodes, 7 of 15 only blue nodes, 13 of 47 only hot and 7 of 13 parasentinel nodes harboured metastases.
  
  
  CONCLUSIONS
  The NEW START recommended, combined superficial injection techniques, have high localisation rates. Pre-operative sentinel node imaging is recommended and a template for reporting is provided.
authors.affiliation: University Department of Surgery, Royal Free and University College Medical School, Pond Street, London NW3 2QG, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Somasundaram
authors.forename: D W
authors.initials: DW
authors.lastname: Chicken
authors.forename: W A
authors.initials: WA
authors.lastname: Waddington
authors.forename: J
authors.initials: J
authors.lastname: Bomanji
authors.forename: P J
authors.initials: PJ
authors.lastname: Ell
authors.forename: M R S
authors.initials: MR
authors.lastname: Keshtgar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology*; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012394:Rosaniline Dyes / Q000008:administration & dosage; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage*; D006113:United Kingdom
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; C008769:sulfan blue