Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: Results of a multiinstitutional study

Kelly M. McMasters, Sandra L. Wong, Robert C G Martin, Celia Chao, Todd M. Tuttle, R. Dirk Noyes, David J. Carlson, Alison L. Laidley, Terre Q. McGlothin, Philip B. Ley, C. Matthew Brown, Rebecca L. Glaser, Robert E. Pennington, Peter S. Turk, Diana Simpson, Patricia B. Cerrito, Michael J. Edwards

Research output: Contribution to journalArticle

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Abstract

Objective: To determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: The optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique. Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1-2, NO breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radio activity of the nodes. One-way analysis of variance and chisquare tests were used for statistical analysis. Results: A total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94%) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5%, 7.8%, and 6.5% (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five- to sevenfold higher with the dermal injection technique compared with peritumoral injection. Conclusions: Dermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five- to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve.

Original languageEnglish (US)
Pages (from-to)676-687
Number of pages12
JournalAnnals of Surgery
Volume233
Issue number5
DOIs
StatePublished - 2001
Externally publishedYes

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Sentinel Lymph Node Biopsy
Colloids
Breast Neoplasms
Skin
Injections
Coloring Agents

ASJC Scopus subject areas

  • Surgery

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Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy : Results of a multiinstitutional study. / McMasters, Kelly M.; Wong, Sandra L.; Martin, Robert C G; Chao, Celia; Tuttle, Todd M.; Noyes, R. Dirk; Carlson, David J.; Laidley, Alison L.; McGlothin, Terre Q.; Ley, Philip B.; Brown, C. Matthew; Glaser, Rebecca L.; Pennington, Robert E.; Turk, Peter S.; Simpson, Diana; Cerrito, Patricia B.; Edwards, Michael J.

In: Annals of Surgery, Vol. 233, No. 5, 2001, p. 676-687.

Research output: Contribution to journalArticle

McMasters, KM, Wong, SL, Martin, RCG, Chao, C, Tuttle, TM, Noyes, RD, Carlson, DJ, Laidley, AL, McGlothin, TQ, Ley, PB, Brown, CM, Glaser, RL, Pennington, RE, Turk, PS, Simpson, D, Cerrito, PB & Edwards, MJ 2001, 'Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: Results of a multiinstitutional study', Annals of Surgery, vol. 233, no. 5, pp. 676-687. https://doi.org/10.1097/00000658-200105000-00012
McMasters, Kelly M. ; Wong, Sandra L. ; Martin, Robert C G ; Chao, Celia ; Tuttle, Todd M. ; Noyes, R. Dirk ; Carlson, David J. ; Laidley, Alison L. ; McGlothin, Terre Q. ; Ley, Philip B. ; Brown, C. Matthew ; Glaser, Rebecca L. ; Pennington, Robert E. ; Turk, Peter S. ; Simpson, Diana ; Cerrito, Patricia B. ; Edwards, Michael J. / Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy : Results of a multiinstitutional study. In: Annals of Surgery. 2001 ; Vol. 233, No. 5. pp. 676-687.
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title = "Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: Results of a multiinstitutional study",
abstract = "Objective: To determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: The optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique. Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1-2, NO breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radio activity of the nodes. One-way analysis of variance and chisquare tests were used for statistical analysis. Results: A total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94{\%}) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5{\%}, 7.8{\%}, and 6.5{\%} (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five- to sevenfold higher with the dermal injection technique compared with peritumoral injection. Conclusions: Dermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five- to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve.",
author = "McMasters, {Kelly M.} and Wong, {Sandra L.} and Martin, {Robert C G} and Celia Chao and Tuttle, {Todd M.} and Noyes, {R. Dirk} and Carlson, {David J.} and Laidley, {Alison L.} and McGlothin, {Terre Q.} and Ley, {Philip B.} and Brown, {C. Matthew} and Glaser, {Rebecca L.} and Pennington, {Robert E.} and Turk, {Peter S.} and Diana Simpson and Cerrito, {Patricia B.} and Edwards, {Michael J.}",
year = "2001",
doi = "10.1097/00000658-200105000-00012",
language = "English (US)",
volume = "233",
pages = "676--687",
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TY - JOUR

T1 - Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy

T2 - Results of a multiinstitutional study

AU - McMasters, Kelly M.

AU - Wong, Sandra L.

AU - Martin, Robert C G

AU - Chao, Celia

AU - Tuttle, Todd M.

AU - Noyes, R. Dirk

AU - Carlson, David J.

AU - Laidley, Alison L.

AU - McGlothin, Terre Q.

AU - Ley, Philip B.

AU - Brown, C. Matthew

AU - Glaser, Rebecca L.

AU - Pennington, Robert E.

AU - Turk, Peter S.

AU - Simpson, Diana

AU - Cerrito, Patricia B.

AU - Edwards, Michael J.

PY - 2001

Y1 - 2001

N2 - Objective: To determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: The optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique. Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1-2, NO breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radio activity of the nodes. One-way analysis of variance and chisquare tests were used for statistical analysis. Results: A total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94%) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5%, 7.8%, and 6.5% (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five- to sevenfold higher with the dermal injection technique compared with peritumoral injection. Conclusions: Dermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five- to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve.

AB - Objective: To determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: The optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique. Methods: The University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1-2, NO breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radio activity of the nodes. One-way analysis of variance and chisquare tests were used for statistical analysis. Results: A total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94%) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5%, 7.8%, and 6.5% (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five- to sevenfold higher with the dermal injection technique compared with peritumoral injection. Conclusions: Dermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five- to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve.

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