Comparison of a 1-day and a 2-day protocol for lymphatic mapping and sentinel lymph node biopsy in patients with nonpalpable breast cancer

Abstract

Purpose To compare the identification rate of the sentinel node in a 1-day protocol versus a 2-day protocol in patients with a nonpalpable breast carcinoma. Methods In the 1-day protocol an average dose of 120 MBq 99m Tc-nanocolloid was injected intratumorally on the day of surgery, and in the 2-day protocol an average dose of 370 MBq 99m Tc-nanocolloid was injected intratumorally the day before surgery. Both a gamma ray detection probe and patent blue were used to locate the sentinel node. Results In 57 of 67 patients (85%) treated in the 1-day protocol and in 51 of 56 patients (91%) treated in the 2-day protocol the sentinel node was detected (p=0.311). Of the patients in the 1-day protocol and the 2-day protocol, respectively, 18 (27%) and 13 (23%) showed metastasis (p=0.975) Conclusion There was no significant difference in the identification rate of the sentinel node between the 1-day protocol and the 2-day protocol in patients diagnosed with a nonpalpable breast carcinoma.

Combining dose and injection volume for good performance of a specific radiopharmaceutical for sentinel node detection

“…This radiopharmaceutical opens new possibilities for lymphatic system agents, until now they have been primarily designed taking into account their particle size (radiolabeled colloids) together with functional and mechanical properties of the lymphatic system [20]. Therefore, the suitable tracer performance in sentinel node detection does not only depend on its own features, other parameters related with lymphatic functioning like injection volume and dose must be considered [21,22]. In literature, it can find different radiotracers for this purpose with good clinical results by means of a proper selection of the related variables with the biological performance, despite of pronounced molecular differences.…”

Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical

“…The activity of 99m Tc-labelled nanocolloid used in our patients was not small compared with the common trend in the literature (Koizumi et al, 2003;Gutman et al, 2006;Wang et al, 2007;van Esser et al, 2009;Seok et al, 2009). We used 50 MBq (±10%) for same-day and 110 MBq (±10%) for 2-day procedures.…”

“…There is no consensus about the amount of 99m Tc-activity required for optimal SN diagnostics, and the literature shows very different activities injected (Koizumi et al, 2003;Buscombe et al, 2007;van Esser et al, 2009), sometimes compensating for the physical decay of Tc-99m with longer time intervals between injection and biopsy and sometimes not (Veronesi et al, 2006).…”

An Ultralow-Dose 1-Day Protocol With Activities Lower Than 20 MBq for the Detection of Sentinel Lymph Nodes in Breast Cancer—Experiences After 150 Cases

“…Although it has been proposed that peritumoral injection of the radioactive tracer yields lower detection rates (91%) than dermal/subdermal and subareolar/periareolar injection (96.7% and 97.0%, respectively), 13 our results of peritumoral injection were as high as 98.7% for lymphoscintigraphy and 96.7% for intraoperative detection for the radioactive tracer. Published comparisons of 1-day and 2-day protocols demonstrated intraoperative detection rates of 85% for the 1-day protocol and 91% for the 2-day protocol using a standard tracer dose 10 and 99.3% for the 1-day protocol and 96% for the 2-day protocol using a protocol with mean doses of 22.3 (1-day protocol) and 40.4 MBq (2-day protocol). 9 Interestingly, the detection rate for the 1-day protocol with the mentioned mean activity of 22.3 MBq in this study is very similar to our results with a mean activity of 17.8 MBq and a detection rate of 100%.…”

“… 7 , 8 Sentinel lymph node detection rates have been reported to be equivalent in 1-day and 2-day protocols. 9 – 12 Although it has been suggested that the minimum absolute activity for 1-day protocols should not be lower than 90 MBq, 13 the European Association of Nuclear Medicine and Society of Nuclear Medicine and Molecular Imaging practice guideline is reporting a range of activities between 3.7 and 370 MBq as being used in published protocols. Activities of 5 to 30 MBq in 1-day protocols and 150 MBq in 2-day protocols are stated to be generally considered sufficient in this guideline.…”