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Sentinel Lymph Node Detection in Patients with Early-Stage Breast Cancer: Comparison of Periareolar and Subdermal/Peritumoral Injection Techniques

¹ Dottorato di Ricerca Radioimmunolocalizzazione dei Tumori Umani, Università Torino, Torino, Italy
² Servizio di Medicina Nucleare Universitario, Ospedale S. Giovanni Battista, Torino, Italy
³ Reparto di Chirurgia Oncologica 10, Ospedale S. Giovanni Battista, Torino, Italy

Periareolar (PA) injection offers several potential advantages over other techniques for visualizing sentinel lymph nodes (SLNs) in patients with early breast cancer. However, few studies have been published on this procedure. This study was designed to validate PA injection technique and compare it with the subdermal/peritumoral (SD/PT) injection technique. Methods: The study included 324 patients in whom 330 breast cancers (T) had been identified by biopsy. This population was divided in 4 groups: (A) 148 patients (150 T) in whom lymphatic mapping was performed by injecting radiotracer with the SD/PT technique; (B) 59 patients (60 T) in whom lymphatic mapping was performed with a combination of blue dye injected with the PA technique and radiotracer injected with the SD/PT technique; (C) 58 patients (60 T) in whom blue dye was injected subdermally and radiotracer was injected periareolarly; and (D) 59 patients (60 T) in whom both blue dye and radiotracer were injected periareolarly. Results: Concordances in the SLN detection rate between blue dye and radiotracer in groups B, C, and D were 98.1%, 100%, and 100%, respectively. The SLN identification rates with the PA technique were 98.3% and 95%, respectively, for radiotracer and blue dye. With the SD/PT technique, these rates were 90.5% and 88.3%, respectively, for radiotracer and blue dye. At lymphoscintigraphy, SLN visualization required the acquisition of late images (3 h after the injection) in 20% of patients who received PA injections and 39.5% of patients who received SD/PT injections. Conclusion: These findings validate the PA injection technique and underline some of its reported advantages in comparison with the SD/PT technique.

Key Words: breast cancer • lymphatic mapping • sentinel lymph node • periareolar injection

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