title: Accuracy of non-operative identification of the sentinel lymph node using combined gamma and ultrasound scanning.
abstract: OBJECTIVE
  To assess how accurately the sentinel lymph node (SLN) can be identified percutaneously, using gamma probe and ultrasound technology.
  
  
  METHODS
  Women with breast cancer, scheduled for wide local excision or mastectomy with SLN biopsy (SLNB), were included. Peri-areolar intradermal injection of technetium-99 nanocolloid was performed on the morning of surgery and 1-2 ml of blue dye was injected in the peri-areolar region once the patient was anaesthetized. Prior to surgery, a gamma probe was used over the skin to identify any hot spot that could represent a SLN. Ultrasound, guided by the hot spot, was then used to visualize potential SLNs and guide the insertion of a localizing wire. The accuracy in localizing the SLN by preoperative gamma-probe guided ultrasonography was assessed by comparison to SLNB.
  
  
  RESULTS
  A SLN was correctly identified and marked using gamma-probe guided ultrasonography in 44 of 59 cases (75%; 95% CI: 63-86%).
  
  
  CONCLUSIONS
  This study supports the case for investigating percutaneous gamma probe and ultrasound guided interventions in the axilla in women with breast cancer, as a potential alternative to surgical SLNB.
authors.affiliation: Medical Research Institute, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK. Electronic address: p.j.whelehan@dundee.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Whelehan
authors.affiliation: Medical Research Institute, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Vinnicombe
authors.affiliation: Department of Breast Surgery, Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Brown
authors.affiliation: Breast Imaging Department, Ninewells Hospital, Dundee DD1 9SY, UK.
authors.forename: D
authors.initials: D
authors.lastname: McLean
authors.affiliation: Medical Research Institute, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
authors.forename: A
authors.initials: A
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005720:Gamma Rays; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin