Previous day breast lymphoscintigraphy injection, a practical effective approach

Objectives A retrospective review of different injection approaches, same or previous day, different dose amounts was done to determine the most effective approach for intraoperative sentinel lymph node identification using the *gamma probe.

Methods 122 new breast cancer patients from a single hospital seen over 4.5 years with subcutaneous injection of Technetium 99m filtered sulfur colloid into the upper outer quadrant subareolar region of the involved breast in doses of 0.662 -1 mCi for same day(SD), 0.78 to 1.1 mCi for previous day low dose ( PDL) and 4-4.2 mCi for previous day high dose ( PDH) were retrospectively analyzed. 43 left and 45 right breast cancer in SD; 12 left and 12 right breast cancer in the PDL group ; 8 left , 2 right in PDH, including one bilateral in PDL and PDH group.

Results 39% SD patients had imaging done compared to 73% and 83% respectively in PDL and PDH groups. Axillary Lymph nodal uptake on scan was 59%, 63% and 80% in SD, PDL and PDH respectively and higher counts noted in the PDH group.

Conclusions The next day high dose injection was practical, more convenient approach for our departmental patient flow, allowing more post injection imaging, identifying more patients with axillary nodal activity on scan and higher nodal count activity intraoperatively without delaying or interfering with the scheduled surgery start time the next day . Extra patient visit for the lymphoscintigraphy procedure and minimally higher patient radiation dose from higher injected radioactivity were two negatives

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RESULTS TABLE