title: Impact of delayed lymphoscintigraphy for sentinel lymphnode biopsy for breast cancer.
abstract: BACKGROUND
  Despite universal adoption of sentinel lymph node biopsy (SLNB) for breast cancer, there remains no standardized protocol for preoperative lymphoscintographic assessment of sentinel nodes. Both immediate and delayed lymphoscintigraphy are currently utilized, although it is unclear how delayed imaging impacts SLN identification.
  
  
  METHODS
  Among patients diagnosed with breast cancer who underwent SLNB at Duke from 2011 to 2012, two protocols for preoperative lymphoscintigraphy were used: protocol A included both immediate and delayed lymphoscintigraphy (n = 152), while protocol B involved immediate lymphoscintigraphy only (n = 103).
  
  
  RESULTS
  The overall intraoperative SLN identification rate was 98.4% and did not differ between groups. A lower number of SLN were visualized on the immediate scan using protocol A compared to protocol B (P < 0.001). Although a greater total number of nodes was excised using protocol A, this result was not statistically significant (P = 0.08). Moreover, there was no significant difference in the number of negative SLN between groups (P = 0.51).
  
  
  CONCLUSIONS
  We found no significant impact on identification rate or number of SLN excised with the use of delayed versus immediate imaging. These findings support abandoning delayed lymphoscintographic imaging, except in those cases where aberrant drainage is suspected.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.|Computational Biology and Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Hanghang
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Medicine, Duke University, Durham, North Carolina.
authors.forename: Karissa
authors.initials: K
authors.lastname: Heck
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Pruitt
authors.affiliation: Department of Radiology, North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Terence Z
authors.initials: TZ
authors.lastname: Wong
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Randall P
authors.initials: RP
authors.lastname: Scheri
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Georgiade
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Ikwunze
authors.initials: I
authors.lastname: Ichite
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013997:Time Factors
keywords: breast cancer; delayed lymphoscintigraphy; immediate lymphoscintigraphy; sentinel lymph node biopsy