RT Journal Article
SR Electronic
T1 Lymphoscintigraphy and Sentinel Node Localization in Breast Cancer Patients: A Comparison Between 1-Day and 2-Day Protocols
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 420
OP 423
VO 42
IS 3
A1 Yeung, Henry W.D.
A1 Cody III, Hiram S.
A1 Turlakow, Alla
A1 Riedel, Elyn R.
A1 Fey, Jane
A1 Gonen, Mithat
A1 Nuñez, Rodolfo
A1 Yeh, Samuel D.
A1 Larson, Steven M.
YR 2001
UL http://jnm.snmjournals.org/content/42/3/420.abstract
AB The purpose of this study was to compare the results of isotope injection the morning of surgery (1-d protocol) with isotope injection the day before surgery (2-d protocol) in patients having sentinel lymph node (SLN) biopsy for breast cancer. Methods: The 1-d (protocol 1) and 2-d (protocol 2) protocols included 514 and 152 patients, respectively, treated contemporaneously by surgeons experienced with the SLN biopsy technique. All had preoperative lymphoscintigraphy (LSG) and SLN biopsy using both blue dye and 99mTc–sulfur colloid. All patients had a single-site intradermal injection of unfiltered 99mTc–sulfur colloid in 0.05 mL normal saline: 3.7 MBq (0.1 mCi) on the morning of surgery for protocol 1 and 18.5 MBq (0.5 mCi) on the afternoon before surgery for protocol 2. Results: The patients in protocols 1 and 2 were comparable in terms of age, tumor size, tumor location, histologic type, node positivity, and frequency of a previous surgical biopsy. Comparing protocols 1 and 2, early (30 min) LSG images found the SLN equally often (69% vs. 68%). Isotope identified the SLN equally often at surgery (93% vs. 97%) as did isotope plus dye (98% vs. 99%). A comparable number of SLNs was found (2.5 vs. 2.8 per axilla), and the concordance between isotope and dye in the SLN was also comparable (97% vs. 95%). Late LSG images (at 2 h, possible only for protocol 2) identified the SLN in significantly more patients compared with early images (86% vs. 68%). Conclusion: With unfiltered 99mTc–sulfur colloid injected intradermally, the results of SLN biopsy under the 1-d and 2-d protocols are virtually identical. A 2-d protocol allows increased efficiency in scheduling, both for nuclear medicine physicians and for the operating room, with no compromise in the effectiveness of SLN mapping.