title: Technical effects of adding 1 % lidocaine to technetium sulfur colloid for sentinel lymphatic mapping in early breast cancer: analysis of data from a double-blind randomized controlled trial.
abstract: BACKGROUND
  A practice standard in sentinel lymph node (SLN) mapping in breast cancer is intradermal injection of technetium-99m sulfur colloid (Tc-99m), resulting in significant patient discomfort and pain. A previous randomized controlled trial showed that adding lidocaine to Tc-99m significantly reduced radioisotope injection-related pain. We tested whether 1 % lidocaine admixed with Tc-99m affects feasibility of SLN mapping.
  
  
  METHODS
  Between January 2006 and April 2009, 140 patients with early breast cancer were randomly assigned (1:1:1:1) to receive standard topical 4 % lidocaine cream and intradermal Tc-99m (control) or to one of three other study groups: topical placebo cream and injection of Tc-99m containing sodium bicarbonate (NaHCO3), 1 % lidocaine, or both. All SLN data were collected prospectively.
  
  
  RESULTS
  Study groups were comparable for clinicopathological parameters. As previously reported, the addition of 1 % lidocaine to the radioisotope solution significantly improved patient comfort. Overall SLN identification rate in the trial was 93 %. Technical aspects of SLN biopsy were similar for all groups, including time from injection to operation, first SLN (SLN 1) gamma probe counts, ex vivo counts for SLN 1 and SLN 2, and axillary bed counts. SLN identification rates were comparable statistically: control (96 %), lidocaine (90 %), sodium bicarbonate (97 %), and sodium bicarbonate-lidocaine (90 %). The control group had a significantly higher SLN 2/SLN 1 ex vivo count ratio, and the number of SLNs detected was significantly reduced in the lidocaine versus no-lidocaine groups (p < 0.05).
  
  
  CONCLUSIONS
  Addition of 1 % lidocaine to standard radioisotope solution for SLN mapping in breast cancer is associated with fewer SLNs detected, but it does not appear to compromise SLN identification.
authors: Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors: Cletus A
authors: CA
authors: Arciero
authors: Leonard R
authors: LR
authors: Henry
authors: Robin S
authors: RS
authors: Howard
authors: George E
authors: GE
authors: Peoples
authors: Anton J
authors: AJ
authors: Bilchik
authors: Itzhak
authors: I
authors: Avital
authors: Chester C
authors: CC
authors: Buckenmaier Iii
authors: Alexander
authors: A
authors: Stojadinovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000473:pathology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000009:adverse effects; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid; D008012:Lidocaine