Intraoperative Injection of Subareolar or Dermal Radioisotope Results in Predictable Identification of Sentinel Lymph Nodes in Breast Cancer

Johnson, Chad; Boneti, Cristiano; Korourian, Soheila; Adkins, Laura; Klimberg, V. Suzanne

doi:10.1097/sla.0b013e31823005bf

Cited by 30 publications

(31 citation statements)

References 33 publications

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“…36,37 In brief, a subareolar plexus injection of 1.0 mCi of unfiltered technetium sulfur colloid diluted to a final volume of 4 mL was intraoperatively administered immediately after induction of general anesthesia. After routine prep and drape, a handheld gamma probe (Neoprobe Corporation, Dublin, OH) was used to localize radioactivity (hot lymph node) before skin incision.…”

Section: Methodsmentioning

confidence: 99%

Axillary reverse mapping: Five-year experience

Ochoa

Korourian

Boneti

et al. 2014

Surgery

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BACKGROUNDWe hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping, ARM) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema.METHODSThis institutional review board-approved study from May 2006 to October 2011 involved 360 patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected subareolarly and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema.RESULTSA group of 360 patients underwent SLNB and/or ALND. A total of 348 patients underwent a SLNB. Of those, 237/348(68.1%) had a SLNB only and 111/348(31.9%) went on to an ALND due to a positive axilla. An additional 12/360(3.3%) axilla had ALND due to a clinically positive axilla/preoperative core needle biopsy. In 96%(334/348) of patients with SLNB, breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14/348(4%). Blue lymphatics were identified in 80/237(33.7%) of SLN incisions and in 93/123(75.4%) ALND. Average follow-up was 12 months (range 3 to 48 months) and resulted in a SLNB lymphedema rate of 1.7%(4/237) and ALND of 2.4%(3/123).CONCLUSIONSARM identified significant lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lower lymphedema rates.

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Section: Methodsmentioning

confidence: 99%

Axillary reverse mapping: Five-year experience

Ochoa

Korourian

Boneti

et al. 2014

Surgery

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“…The injection can be either superficial (subdermal, periareolar, or subareolar) or deep (peritumoral) (11)(12)(13). Superficial injections are easier to perform than deep injections but may not provide full information on drainage.…”

Section: Radiopharmaceuticals and Injection Parametersmentioning

confidence: 99%

Lymphoscintigraphy and Sentinel Nodes

2015

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) generic fundamentals of lymphoscintigraphy procedures of sentinel lymph node biopsy (SLNB) protocols; (2) specific injection and imaging components of SLNB protocols used in the management of patients with breast cancer, melanoma, and head and neck malignancies; and (3) specific indications of breast cancer, melanoma, and head and neck malignancies that suggest inclusion of a SLNB in the management of a patient.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through June 2018.It has been validated that sentinel lymph node biopsy (SLNB) shows whether a patient's breast cancer or melanoma has spread to regional lymph nodes. As a result, management of patients with these cancers has been revolutionized. SLNB has replaced axillary lymph node dissection (ALND) as the staging modality of choice for early breast cancer and has replaced complete lymph node dissection as the staging modality of choice for melanoma in patients whose SLNBs indicate no metastases. Recently concluded multicenter, randomized trials for breast cancer with 5-to 10-y outcome data have shown no significant differences in disease-free survival rates or overall survival rates between SLNB and ALND groups but have shown significantly lower morbidity with SLNB than with ALND. The lowest false-negative rates (5.5%-6.7%) were seen in studies that used preoperative lymphoscintigraphy and dual mapping during surgery. To assess the survival impact of SLNB in melanoma, the Multicenter Selective Lymphadenectomy Trial I was performed. Melanoma-specific survival rates were not different between subjects randomized to SLNB with lymphadenectomy for nodal metastasis on biopsy and subjects randomized to observation with lymphadenectomy for nodal relapse. However, the 10-y disease-free survival rates were better for the SLNB group than for the observation group, specifically among patients with intermediate-thickness melanomas or thick melanomas.

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“…Dixon [5] reported an SNIDR of 98% with 163 IRCI. Johnson [6] reported on 775 IRCI; the SNIDR remained excellent at 98.6%. Stell [7] compared the incidence of positive sentinel lymph nodes between 102 patients with PRCI and that of 112 patients with IRCI.…”

Section: Discussionmentioning

confidence: 93%