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

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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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Acknowledgments

The authors would like to thank Suzanne Knott, Cheri Balser, Janine Cobar, and the nursing staff at JamesCare in the Dublin Breast Care Center for their assistance in patient randomization and registration process, the Nuclear Medicine Department staff for their assistance with the preparation and injection of 99mTc-sulfur colloid and performance of preoperative lymphoscintigraphy, and The Author G. James Hospital operating room staff for their assistance with intraoperative data collection.

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Authors and Affiliations

  1. Section of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA

    Stephen P. Povoski MD, Johannah Clarke CNP, MS, William E. Burak MD, Michael J. Walker MD, William E. Carson MD, Lisa D. Yee MD, Doreen M. Agnese MD & William B. Farrar MD

  2. Section of Nuclear Medicine, Department of Radiology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA

    Johannes O. Olsen MD, Rodney V. Pozderac MD & Nathan C. Hall MD, PhD

  3. Center for Biostatistics, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA

    Donn C. Young PhD

  4. N-924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA

    Stephen P. Povoski MD

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  1. Stephen P. Povoski MD
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  2. Johannes O. Olsen MD
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Correspondence to Stephen P. Povoski MD.

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Povoski, S.P., Olsen, J.O., Young, D.C. et al. Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer. Ann Surg Oncol 13, 1412–1421 (2006). https://doi.org/10.1245/s10434-006-9022-z

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  • DOI: https://doi.org/10.1245/s10434-006-9022-z

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