This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tuttle, T. M. Articles by McMasters, K. M. Search for Related Content PubMed PubMed Citation Articles by Tuttle, T. M. Articles by McMasters, K. M. Related Collections Sentinel lymph node

Subareolar Injection of ^99mTc Facilitates Sentinel Lymph Node Identification

From the Department of Surgery (TMT, MC, RC, KJO, TJ, RW, JF) and the Institute of Research and Education (KS), Park Nicollet Clinic, Minneapolis, Minnesota; the Department of Surgery (TMT), University of Minnesota, Minneapolis, Minnesota; and the Department of Surgery (KM), University of Louisville, Louisville, Kentucky.

Correspondence: Address correspondence and reprint requests to: Todd M. Tuttle, MD, Surgical Oncology, University of Minnesota, Mayo Mail Code 195, 420 Delaware St. SE, Minneapolis, MN 55455; Fax: 612-624-6969; E-mail: tuttl006{at}umn.edu

Background: Sentinel lymph node (SLN) biopsy with the standard intraparenchymal injection has been accepted as an alternative to routine axillary dissection for patients with breast cancer. However, the identification and false-negative rates with this method can vary widely from surgeon to surgeon. The subareolar location contains a rich lymphatic network and represents a potential site of injection for SLN identification.

Methods: Between August 1, 1999, and December 31, 2000, we performed 159 SLN biopsy procedures on 158 patients with breast cancer. For each patient, ^99mTc-labeled sulfur colloid was injected into the subareolar location, and 1% isosulfan blue dye was given as an intraparenchymal injection.

Results: In every case, at least one radioactive SLN was identified with the subareolar injection of technetium; a blue SLN was found in 97% of the cases. The blue SLN was also radioactive in 98% of the cases, indicating that the blue dye injected around the tumor and the technetium injected into the subareolar location drained to the same SLN.

Conclusions: Subareolar injection of technetium can improve SLN identification rates for breast cancer. The simplicity and accuracy of this technique may also reduce the variable results reported with the standard intraparenchymal method.

Key Words: Sentinel lymph node biopsy • Lymphatic mapping • Subareolar injection • Breast cancer

This article has been cited by other articles:

				N. Biglia, L. Mariani, L. Sgro, P. Mininanni, G. Moggio, and P. Sismondi Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment Endocr. Relat. Cancer, September 1, 2007; 14(3): 549 - 567. [Abstract] [Full Text] [PDF]

				J.-F. Rodier, M. Velten, M. Wilt, P. Martel, G. Ferron, V. Vaini-Elies, H. Mignotte, A. Bremond, J.-M. Classe, F. Dravet, et al. Prospective Multicentric Randomized Study Comparing Periareolar and Peritumoral Injection of Radiotracer and Blue Dye for the Detection of Sentinel Lymph Node in Breast Sparing Procedures: FRANSENODE Trial J. Clin. Oncol., August 20, 2007; 25(24): 3664 - 3669. [Abstract] [Full Text] [PDF]

				D. Pavlista, O. Eliska, M. Duskova, M. Zikan, and D. Cibula Localization of the Sentinel Node of the Upper Outer Breast Quadrant in the Axillary Quadrants Ann. Surg. Oncol., February 1, 2007; 14(2): 633 - 637. [Abstract] [Full Text] [PDF]

				S. P. Povoski, J. O. Olsen, D. C. Young, J. Clarke, W. E. Burak, M. J. Walker, W. E. Carson, L. D. Yee, D. M. Agnese, R. V. Pozderac, et al. Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer Ann. Surg. Oncol., November 1, 2006; 13(11): 1412 - 1421. [Abstract] [Full Text] [PDF]

				G. D'Eredita, C. Giardina, A. M. Guerrieri, and T. Berardi A Further Validation of Subareolar Injection Technique for Breast Sentinel Lymph Node Biopsy Ann. Surg. Oncol., May 1, 2006; 13(5): 701 - 707. [Abstract] [Full Text] [PDF]

				N. Wada, S. Imoto, C. Yamauchi, T. Hasebe, A. Ochiai, and S. Ebihara Correlation Between Concordance of Tracers, Order of Harvest, and Presence of Metastases in Sentinel Lymph Nodes With Breast Cancer Ann. Surg. Oncol., June 1, 2005; 12(6): 497 - 503. [Abstract] [Full Text] [PDF]

				T. G. Zogakis, R. E. Wetherille, R. D. Christensen, K. J. Ose, J. D. Friedman, M. Colbert, C. A. Svendsen, O. K. Sanan, and T. M. Tuttle Intraoperative Subareolar Injection of 99mTc-Labeled Sulfur Colloid Results in Consistent Sentinel Lymph Node Identification Ann. Surg. Oncol., February 1, 2005; 12(2): 167 - 172. [Abstract] [Full Text] [PDF]

				A. Chagpar, R. C. Martin III, C. Chao, S. L. Wong, M. J. Edwards, T. Tuttle, and K. M. McMasters Validation of Subareolar and Periareolar Injection Techniques for Breast Sentinel Lymph Node Biopsy Arch Surg, June 1, 2004; 139(6): 614 - 620. [Abstract] [Full Text] [PDF]

				E. Pelosi, M. Bello, M. Giors, A. Ala, R. Giani, R. Bussone, and G. Bisi Sentinel Lymph Node Detection in Patients with Early-Stage Breast Cancer: Comparison of Periareolar and Subdermal/Peritumoral Injection Techniques J. Nucl. Med., February 1, 2004; 45(2): 220 - 225. [Abstract] [Full Text] [PDF]

				B. R. Krynyckyi, C. K. Kim, M. R. Goyenechea, P. T. Chan, Z.-Y. Zhang, and J. Machac Clinical Breast Lymphoscintigraphy: Optimal Techniques for Performing Studies, Image Atlas, and Analysis of Images RadioGraphics, January 1, 2004; 24(1): 121 - 145. [Abstract] [Full Text] [PDF]

				G. D'Eredita', F. Ferrarese, V. Cecere, S. T. Massa, F. de Carne, and G. Fabiano Subareolar Injection May Be More Accurate Than Other Techniques for Sentinel Lymph Node Biopsy in Breast Cancer Ann. Surg. Oncol., October 1, 2003; 10(8): 942 - 947. [Abstract] [Full Text] [PDF]