Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy

Anees Chagpar, Robert C. Martin, Celia Chao, Sandra L. Wong, Michael J. Edwards, Todd Tuttle, Kelly M. McMasters, Nora M. Hansen, Howard Silberman, Gary B. Talpos, Anton Joel Bilchick, Mary C. McCarthy, Max Schmidt, James E. Goodnight

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Hypothesis: Subareolar or periareolar injection of radioactive technetium sulfur colloid is equivalent to other injection techniques for breast cancer sentinel lymph node (SLN) biopsy. Design and Setting: Prospective, multicenter clinical trial. Patients: A total of 3961 individuals with clinical stage I and II breast cancer. Interventions: All patients underwent attempted SLN biopsy followed by completion axillary dissection. Injection technique was determined by the preference of each participating surgeon. Most surgeons had little or no experience with SLN biopsy before participation in this study. Main Outcome Measures: The SLN identification and false-negative rates. Results: An SLN biopsy was performed in 3961 patients using blue dye alone or radioactive colloid plus blue dye. Subareolar and periareolar radioactive colloid injection techniques were associated with SLN identification rates of 99.3% and 95.6%, respectively, with false-negative rates of 8.3% and 8.9%, respectively. The identification rates were significantly higher for these 2 techniques than for peritumoral injection of radioactive colloid (91.1%) or the use of blue dye alone (88.5%) (P<.001). The false-negative rates were similar for all techniques. Conclusions: Although many medical centers have adopted subareolar and periareolar radioactive colloid injections because of their simplicity and convenience, a paucity of data from a few single-institutional studies has existed to substantiate the false-negative rates associated with these techniques. The results of this multicenter study establish the validity of subareolar and periareolar radioactive colloid injections and support the hypothesis that the lymphatic drainage of the entire breast is to the same few SLNs.

Original languageEnglish (US)
Pages (from-to)614-620
Number of pages7
JournalArchives of Surgery
Volume139
Issue number6
DOIs
StatePublished - Jun 2004

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Sentinel Lymph Node Biopsy
Breast
Colloids
Injections
Coloring Agents
Multicenter Studies
Technetium Tc 99m Sulfur Colloid
Breast Neoplasms
Dissection
Drainage
Outcome Assessment (Health Care)
Clinical Trials

ASJC Scopus subject areas

  • Surgery

Cite this

Chagpar, A., Martin, R. C., Chao, C., Wong, S. L., Edwards, M. J., Tuttle, T., ... Goodnight, J. E. (2004). Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy. Archives of Surgery, 139(6), 614-620. https://doi.org/10.1001/archsurg.139.6.614

Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy. / Chagpar, Anees; Martin, Robert C.; Chao, Celia; Wong, Sandra L.; Edwards, Michael J.; Tuttle, Todd; McMasters, Kelly M.; Hansen, Nora M.; Silberman, Howard; Talpos, Gary B.; Bilchick, Anton Joel; McCarthy, Mary C.; Schmidt, Max; Goodnight, James E.

In: Archives of Surgery, Vol. 139, No. 6, 06.2004, p. 614-620.

Research output: Contribution to journalArticle

Chagpar, A, Martin, RC, Chao, C, Wong, SL, Edwards, MJ, Tuttle, T, McMasters, KM, Hansen, NM, Silberman, H, Talpos, GB, Bilchick, AJ, McCarthy, MC, Schmidt, M & Goodnight, JE 2004, 'Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy', Archives of Surgery, vol. 139, no. 6, pp. 614-620. https://doi.org/10.1001/archsurg.139.6.614
Chagpar, Anees ; Martin, Robert C. ; Chao, Celia ; Wong, Sandra L. ; Edwards, Michael J. ; Tuttle, Todd ; McMasters, Kelly M. ; Hansen, Nora M. ; Silberman, Howard ; Talpos, Gary B. ; Bilchick, Anton Joel ; McCarthy, Mary C. ; Schmidt, Max ; Goodnight, James E. / Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy. In: Archives of Surgery. 2004 ; Vol. 139, No. 6. pp. 614-620.
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abstract = "Hypothesis: Subareolar or periareolar injection of radioactive technetium sulfur colloid is equivalent to other injection techniques for breast cancer sentinel lymph node (SLN) biopsy. Design and Setting: Prospective, multicenter clinical trial. Patients: A total of 3961 individuals with clinical stage I and II breast cancer. Interventions: All patients underwent attempted SLN biopsy followed by completion axillary dissection. Injection technique was determined by the preference of each participating surgeon. Most surgeons had little or no experience with SLN biopsy before participation in this study. Main Outcome Measures: The SLN identification and false-negative rates. Results: An SLN biopsy was performed in 3961 patients using blue dye alone or radioactive colloid plus blue dye. Subareolar and periareolar radioactive colloid injection techniques were associated with SLN identification rates of 99.3{\%} and 95.6{\%}, respectively, with false-negative rates of 8.3{\%} and 8.9{\%}, respectively. The identification rates were significantly higher for these 2 techniques than for peritumoral injection of radioactive colloid (91.1{\%}) or the use of blue dye alone (88.5{\%}) (P<.001). The false-negative rates were similar for all techniques. Conclusions: Although many medical centers have adopted subareolar and periareolar radioactive colloid injections because of their simplicity and convenience, a paucity of data from a few single-institutional studies has existed to substantiate the false-negative rates associated with these techniques. The results of this multicenter study establish the validity of subareolar and periareolar radioactive colloid injections and support the hypothesis that the lymphatic drainage of the entire breast is to the same few SLNs.",
author = "Anees Chagpar and Martin, {Robert C.} and Celia Chao and Wong, {Sandra L.} and Edwards, {Michael J.} and Todd Tuttle and McMasters, {Kelly M.} and Hansen, {Nora M.} and Howard Silberman and Talpos, {Gary B.} and Bilchick, {Anton Joel} and McCarthy, {Mary C.} and Max Schmidt and Goodnight, {James E.}",
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AU - Martin, Robert C.

AU - Chao, Celia

AU - Wong, Sandra L.

AU - Edwards, Michael J.

AU - Tuttle, Todd

AU - McMasters, Kelly M.

AU - Hansen, Nora M.

AU - Silberman, Howard

AU - Talpos, Gary B.

AU - Bilchick, Anton Joel

AU - McCarthy, Mary C.

AU - Schmidt, Max

AU - Goodnight, James E.

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N2 - Hypothesis: Subareolar or periareolar injection of radioactive technetium sulfur colloid is equivalent to other injection techniques for breast cancer sentinel lymph node (SLN) biopsy. Design and Setting: Prospective, multicenter clinical trial. Patients: A total of 3961 individuals with clinical stage I and II breast cancer. Interventions: All patients underwent attempted SLN biopsy followed by completion axillary dissection. Injection technique was determined by the preference of each participating surgeon. Most surgeons had little or no experience with SLN biopsy before participation in this study. Main Outcome Measures: The SLN identification and false-negative rates. Results: An SLN biopsy was performed in 3961 patients using blue dye alone or radioactive colloid plus blue dye. Subareolar and periareolar radioactive colloid injection techniques were associated with SLN identification rates of 99.3% and 95.6%, respectively, with false-negative rates of 8.3% and 8.9%, respectively. The identification rates were significantly higher for these 2 techniques than for peritumoral injection of radioactive colloid (91.1%) or the use of blue dye alone (88.5%) (P<.001). The false-negative rates were similar for all techniques. Conclusions: Although many medical centers have adopted subareolar and periareolar radioactive colloid injections because of their simplicity and convenience, a paucity of data from a few single-institutional studies has existed to substantiate the false-negative rates associated with these techniques. The results of this multicenter study establish the validity of subareolar and periareolar radioactive colloid injections and support the hypothesis that the lymphatic drainage of the entire breast is to the same few SLNs.

AB - Hypothesis: Subareolar or periareolar injection of radioactive technetium sulfur colloid is equivalent to other injection techniques for breast cancer sentinel lymph node (SLN) biopsy. Design and Setting: Prospective, multicenter clinical trial. Patients: A total of 3961 individuals with clinical stage I and II breast cancer. Interventions: All patients underwent attempted SLN biopsy followed by completion axillary dissection. Injection technique was determined by the preference of each participating surgeon. Most surgeons had little or no experience with SLN biopsy before participation in this study. Main Outcome Measures: The SLN identification and false-negative rates. Results: An SLN biopsy was performed in 3961 patients using blue dye alone or radioactive colloid plus blue dye. Subareolar and periareolar radioactive colloid injection techniques were associated with SLN identification rates of 99.3% and 95.6%, respectively, with false-negative rates of 8.3% and 8.9%, respectively. The identification rates were significantly higher for these 2 techniques than for peritumoral injection of radioactive colloid (91.1%) or the use of blue dye alone (88.5%) (P<.001). The false-negative rates were similar for all techniques. Conclusions: Although many medical centers have adopted subareolar and periareolar radioactive colloid injections because of their simplicity and convenience, a paucity of data from a few single-institutional studies has existed to substantiate the false-negative rates associated with these techniques. The results of this multicenter study establish the validity of subareolar and periareolar radioactive colloid injections and support the hypothesis that the lymphatic drainage of the entire breast is to the same few SLNs.

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