Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy

Rakhshanda Layeeque, Julie Kepple, Ronda S. Henry-Tillman, Laura Adkins, Rena Kass, Maureen Colvert, Regina Gibson, Anne Mancino, Soheila Korourian, Vicki Klimberg, Kelly M. McMasters, David Berger, Henry Kuerer

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objective: To determine the identification of sentinel lymph node biopsy (SLNB) in breast cancer patients after intraoperative injection of unfiltered technetium-99m sulfur colloid (Tc-99) and blue dye. Background: SLNB guided by a combination of radioisotope and blue dye injection yields the best identification rates in breast cancer patients. Radioisotope is given preoperatively, without local anesthesia, whereas blue dye is given intraoperatively. We hypothesized that, because of the rapid drainage noted with the subareolar injection technique of radioisotope, intraoperative injection would be feasible and less painful for SLN localization in breast cancer patients. Methods: Intraoperative injection of Tc-99 and confirmation blue dye was performed using the subareolar technique for SLNB in patients with operable breast cancer. The time lapse between injection and axillary incision, the background count, the preincision and ex vivo counts of the hot nodes, and the axillary bed counts were documented. The identification rate was recorded. Results: Ninety-six SLNB procedures were done in 88 patients with breast cancer employing intraoperative subareolar injection technique for both radioisotope (all 96 procedures) and blue dye (93 procedures) injections. Ninety-three (97%) procedures had successful identification; all SLNs were hot; 91 (of 93 procedures with blue dye) were blue and hot. The mean time from radioisotope injection to incision was 19.9 minutes (SD 8.5 minutes). The mean highest 10 second count was 88,544 (SD 55,954). Three of 96 (3%) patients with failure of localization had previous excisional biopsies: 1 circumareolar and 2 upper outer quadrant incisions that may have disrupted the lymphatic flow. Conclusion: Intraoperative subareolar injection of radioisotope rapidly drains to the SLNs and allows immediate staging of the axilla, avoiding the need to coordinate diagnostic services and a painful preoperative procedure.

Original languageEnglish (US)
Pages (from-to)841-848
Number of pages8
JournalAnnals of Surgery
Volume239
Issue number6
DOIs
StatePublished - Jun 2004
Externally publishedYes

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Sentinel Lymph Node Biopsy
Radioisotopes
Injections
Coloring Agents
Breast Neoplasms
Technetium Tc 99m Sulfur Colloid
Technetium
Diagnostic Services
Preoperative Care
Axilla
Local Anesthesia
Drainage
Biopsy

ASJC Scopus subject areas

  • Surgery

Cite this

Layeeque, R., Kepple, J., Henry-Tillman, R. S., Adkins, L., Kass, R., Colvert, M., ... Kuerer, H. (2004). Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy. Annals of Surgery, 239(6), 841-848. https://doi.org/10.1097/01.sla.0000128304.13522.00

Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy. / Layeeque, Rakhshanda; Kepple, Julie; Henry-Tillman, Ronda S.; Adkins, Laura; Kass, Rena; Colvert, Maureen; Gibson, Regina; Mancino, Anne; Korourian, Soheila; Klimberg, Vicki; McMasters, Kelly M.; Berger, David; Kuerer, Henry.

In: Annals of Surgery, Vol. 239, No. 6, 06.2004, p. 841-848.

Research output: Contribution to journalArticle

Layeeque, R, Kepple, J, Henry-Tillman, RS, Adkins, L, Kass, R, Colvert, M, Gibson, R, Mancino, A, Korourian, S, Klimberg, V, McMasters, KM, Berger, D & Kuerer, H 2004, 'Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy', Annals of Surgery, vol. 239, no. 6, pp. 841-848. https://doi.org/10.1097/01.sla.0000128304.13522.00
Layeeque R, Kepple J, Henry-Tillman RS, Adkins L, Kass R, Colvert M et al. Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy. Annals of Surgery. 2004 Jun;239(6):841-848. https://doi.org/10.1097/01.sla.0000128304.13522.00
Layeeque, Rakhshanda ; Kepple, Julie ; Henry-Tillman, Ronda S. ; Adkins, Laura ; Kass, Rena ; Colvert, Maureen ; Gibson, Regina ; Mancino, Anne ; Korourian, Soheila ; Klimberg, Vicki ; McMasters, Kelly M. ; Berger, David ; Kuerer, Henry. / Intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy. In: Annals of Surgery. 2004 ; Vol. 239, No. 6. pp. 841-848.
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abstract = "Objective: To determine the identification of sentinel lymph node biopsy (SLNB) in breast cancer patients after intraoperative injection of unfiltered technetium-99m sulfur colloid (Tc-99) and blue dye. Background: SLNB guided by a combination of radioisotope and blue dye injection yields the best identification rates in breast cancer patients. Radioisotope is given preoperatively, without local anesthesia, whereas blue dye is given intraoperatively. We hypothesized that, because of the rapid drainage noted with the subareolar injection technique of radioisotope, intraoperative injection would be feasible and less painful for SLN localization in breast cancer patients. Methods: Intraoperative injection of Tc-99 and confirmation blue dye was performed using the subareolar technique for SLNB in patients with operable breast cancer. The time lapse between injection and axillary incision, the background count, the preincision and ex vivo counts of the hot nodes, and the axillary bed counts were documented. The identification rate was recorded. Results: Ninety-six SLNB procedures were done in 88 patients with breast cancer employing intraoperative subareolar injection technique for both radioisotope (all 96 procedures) and blue dye (93 procedures) injections. Ninety-three (97{\%}) procedures had successful identification; all SLNs were hot; 91 (of 93 procedures with blue dye) were blue and hot. The mean time from radioisotope injection to incision was 19.9 minutes (SD 8.5 minutes). The mean highest 10 second count was 88,544 (SD 55,954). Three of 96 (3{\%}) patients with failure of localization had previous excisional biopsies: 1 circumareolar and 2 upper outer quadrant incisions that may have disrupted the lymphatic flow. Conclusion: Intraoperative subareolar injection of radioisotope rapidly drains to the SLNs and allows immediate staging of the axilla, avoiding the need to coordinate diagnostic services and a painful preoperative procedure.",
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AU - Layeeque, Rakhshanda

AU - Kepple, Julie

AU - Henry-Tillman, Ronda S.

AU - Adkins, Laura

AU - Kass, Rena

AU - Colvert, Maureen

AU - Gibson, Regina

AU - Mancino, Anne

AU - Korourian, Soheila

AU - Klimberg, Vicki

AU - McMasters, Kelly M.

AU - Berger, David

AU - Kuerer, Henry

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N2 - Objective: To determine the identification of sentinel lymph node biopsy (SLNB) in breast cancer patients after intraoperative injection of unfiltered technetium-99m sulfur colloid (Tc-99) and blue dye. Background: SLNB guided by a combination of radioisotope and blue dye injection yields the best identification rates in breast cancer patients. Radioisotope is given preoperatively, without local anesthesia, whereas blue dye is given intraoperatively. We hypothesized that, because of the rapid drainage noted with the subareolar injection technique of radioisotope, intraoperative injection would be feasible and less painful for SLN localization in breast cancer patients. Methods: Intraoperative injection of Tc-99 and confirmation blue dye was performed using the subareolar technique for SLNB in patients with operable breast cancer. The time lapse between injection and axillary incision, the background count, the preincision and ex vivo counts of the hot nodes, and the axillary bed counts were documented. The identification rate was recorded. Results: Ninety-six SLNB procedures were done in 88 patients with breast cancer employing intraoperative subareolar injection technique for both radioisotope (all 96 procedures) and blue dye (93 procedures) injections. Ninety-three (97%) procedures had successful identification; all SLNs were hot; 91 (of 93 procedures with blue dye) were blue and hot. The mean time from radioisotope injection to incision was 19.9 minutes (SD 8.5 minutes). The mean highest 10 second count was 88,544 (SD 55,954). Three of 96 (3%) patients with failure of localization had previous excisional biopsies: 1 circumareolar and 2 upper outer quadrant incisions that may have disrupted the lymphatic flow. Conclusion: Intraoperative subareolar injection of radioisotope rapidly drains to the SLNs and allows immediate staging of the axilla, avoiding the need to coordinate diagnostic services and a painful preoperative procedure.

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