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Published in:

01-11-2006

Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer

Authors: Stephen P. Povoski, MD, Johannes O. Olsen, MD, Donn C. Young, PhD, Johannah Clarke, CNP, MS, William E. Burak, MD, Michael J. Walker, MD, William E. Carson, MD, Lisa D. Yee, MD, Doreen M. Agnese, MD, Rodney V. Pozderac, MD, Nathan C. Hall, MD, PhD, William B. Farrar, MD

Published in: Annals of Surgical Oncology | Issue 11/2006

Abstract

Background

Multiple injection routes, including intradermal (ID), intraparenchymal (IP), and subareolar (SA), are used for ^99mTc-sulfur colloid administration for sentinel lymph node (SLN) mapping and biopsy in breast cancer. The aim of this study was to compare localization by ID, IP, and SA injection routes based on preoperative lymphoscintigraphy and intraoperative identification.

Methods

Four hundred prospectively randomized breast cancers underwent SLN mapping and biopsy.

Results

Preoperative lymphoscintigraphy demonstrated localization to the axilla in 126/133 (95%) ID, 82/132 (62%) IP, and 96/133 (72%) SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.081 IP vs. SA), with a mean duration of preoperative lymphoscintigraphy of 139 ± 18 minutes. Mean time to first localization when localization was demonstrated on preoperative lymphoscintigraphy was 8 ± 14 minutes for ID, 53 ± 49 for IP, and 22 ± 29 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.003 IP vs. SA). Intraoperative identification of a SLN at the time of SLN biopsy was successful in 133/133 (100%) ID, 121/134 (90%) IP, and 126/133 (95%) SA (P < 0.001 ID vs IP; P = 0.014 ID vs. SA; P = 0.168 IP vs. SA), with a mean time from injection of ^99mTc-sulfur colloid to start of SLN biopsy of 288 ± 71 minutes. Mean intraoperative time to harvest the first SLN was 9 ± 4 minutes for ID, 13 ± 6 for IP, and 12 ± 6 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.410 IP vs. SA).

Conclusions

The ID injection route demonstrated a significantly greater frequency of localization, decreased time to first localization on preoperative lymphoscintigraphy, and decreased time to harvest the first SLN. This represents the first prospective randomized clinical trial to confirm superiority of the ID route for administration of ^99mTc-sulfur colloid during SLN mapping and biopsy in breast cancer.

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Title: Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer
Authors: Stephen P. Povoski, MD
Johannes O. Olsen, MD
Donn C. Young, PhD
Johannah Clarke, CNP, MS
William E. Burak, MD
Michael J. Walker, MD
William E. Carson, MD
Lisa D. Yee, MD
Doreen M. Agnese, MD
Rodney V. Pozderac, MD
Nathan C. Hall, MD, PhD
William B. Farrar, MD
Publication date: 01-11-2006
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 11/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9022-z

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Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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