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Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 11/2006

01.11.2006

Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer

verfasst von: Stephen P. Povoski, MD, Johannes O. Olsen, MD, Donn C. Young, PhD, Johannah Clarke, CNP, MS, William E. Burak, MD, Michael J. Walker, MD, William E. Carson, MD, Lisa D. Yee, MD, Doreen M. Agnese, MD, Rodney V. Pozderac, MD, Nathan C. Hall, MD, PhD, William B. Farrar, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2006

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Abstract

Background

Multiple injection routes, including intradermal (ID), intraparenchymal (IP), and subareolar (SA), are used for 99mTc-sulfur colloid administration for sentinel lymph node (SLN) mapping and biopsy in breast cancer. The aim of this study was to compare localization by ID, IP, and SA injection routes based on preoperative lymphoscintigraphy and intraoperative identification.

Methods

Four hundred prospectively randomized breast cancers underwent SLN mapping and biopsy.

Results

Preoperative lymphoscintigraphy demonstrated localization to the axilla in 126/133 (95%) ID, 82/132 (62%) IP, and 96/133 (72%) SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.081 IP vs. SA), with a mean duration of preoperative lymphoscintigraphy of 139 ± 18 minutes. Mean time to first localization when localization was demonstrated on preoperative lymphoscintigraphy was 8 ± 14 minutes for ID, 53 ± 49 for IP, and 22 ± 29 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.003 IP vs. SA). Intraoperative identification of a SLN at the time of SLN biopsy was successful in 133/133 (100%) ID, 121/134 (90%) IP, and 126/133 (95%) SA (P < 0.001 ID vs IP; P = 0.014 ID vs. SA; P = 0.168 IP vs. SA), with a mean time from injection of 99mTc-sulfur colloid to start of SLN biopsy of 288 ± 71 minutes. Mean intraoperative time to harvest the first SLN was 9 ± 4 minutes for ID, 13 ± 6 for IP, and 12 ± 6 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.410 IP vs. SA).

Conclusions

The ID injection route demonstrated a significantly greater frequency of localization, decreased time to first localization on preoperative lymphoscintigraphy, and decreased time to harvest the first SLN. This represents the first prospective randomized clinical trial to confirm superiority of the ID route for administration of 99mTc-sulfur colloid during SLN mapping and biopsy in breast cancer.
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Metadaten
Titel
Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer
verfasst von
Stephen P. Povoski, MD
Johannes O. Olsen, MD
Donn C. Young, PhD
Johannah Clarke, CNP, MS
William E. Burak, MD
Michael J. Walker, MD
William E. Carson, MD
Lisa D. Yee, MD
Doreen M. Agnese, MD
Rodney V. Pozderac, MD
Nathan C. Hall, MD, PhD
William B. Farrar, MD
Publikationsdatum
01.11.2006
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2006
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9022-z

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