Subareolar injection is a better technique for sentinel lymph node biopsy

Smith, Lanette F.; Cross, Michael; Klimberg, V. Suzanne

doi:10.1016/s0002-9610(00)00521-3

Cited by 78 publications

(25 citation statements)

References 8 publications

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“…Many investigators have demonstrated that SLNs could be identified more successfully by SA injection than PT injection [19][20][21][22]. The superiority of the SA injection method is probably due to the following reasons [21].…”

Section: Discussionmentioning

confidence: 99%

Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy

Noguchi

Inokuchi

Zen

2009

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy

Noguchi

Inokuchi

Zen

2009

Journal of Surgical Oncology

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“…Concordance rates between the peritumoral and central techniques ranged from 75.0%, in a small study 18 of 8 patients with multicentric tumors, to 95.4%. [9][10][11][12][13][14]17,20,21 These studies, although adding to the evidence supporting the use of central injection techniques in SLN biopsy, are all relatively small, single-institutional studies. Only 150 patients have previously been studied with concomitant axillary dissection to establish the falsenegative rates for subareolar and periareolar injection.…”

Section: Commentmentioning

confidence: 99%

Validation of Subareolar and Periareolar Injection Techniques for Breast Sentinel Lymph Node Biopsy

et al. 2004

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Subareolar or periareolar injection of radioactive technetium sulfur colloid is equivalent to other injection techniques for breast cancer sentinel lymph node (SLN) biopsy.Design and Setting: Prospective, multicenter clinical trial.Patients: A total of 3961 individuals with clinical stage I and II breast cancer.Interventions: All patients underwent attempted SLN biopsy followed by completion axillary dissection. Injection technique was determined by the preference of each participating surgeon. Most surgeons had little or no experience with SLN biopsy before participation in this study. Main Outcome Measures:The SLN identification and false-negative rates.Results: An SLN biopsy was performed in 3961 patients using blue dye alone or radioactive colloid plus blue dye.Subareolar and periareolar radioactive colloid injection techniques were associated with SLN identification rates of 99.3% and 95.6%, respectively, with false-negative rates of 8.3% and 8.9%, respectively. The identification rates were significantly higher for these 2 techniques than for peritumoral injection of radioactive colloid (91.1%) or the use of blue dye alone (88.5%) (PϽ.001). The false-negative rates were similar for all techniques.Conclusions: Although many medical centers have adopted subareolar and periareolar radioactive colloid injections because of their simplicity and convenience, a paucity of data from a few single-institutional studies has existed to substantiate the false-negative rates associated with these techniques. The results of this multicenter study establish the validity of subareolar and periareolar radioactive colloid injections and support the hypothesis that the lymphatic drainage of the entire breast is to the same few SLNs.

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“…This seems less likely, given the growing belief that the entire breast may drain via the same few lymphatic channels to the axilla and that injection location may be of little importance. 5,32,33 In an earlier analysis with fewer patients, we reported that the FN rate was decreased among patients who underwent dual-agent (blue dye plus radioactive colloid) injection as compared with blue dye alone. 34 This finding has been supported by others.…”

Section: Discussionmentioning

confidence: 97%

Clinicopathologic Factors Associated With False-Negative Sentinel Lymph-Node Biopsy in Breast Cancer

&NA;

2006

Annals of Surgery

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Summary Background Data:Previous studies have suggested a variety of factors that may affect the false negative (FN) rate for sentinel lymph node (SLN) biopsy in breast cancer. Because FN results are relatively rare, no prior studies have had sufficient sample size to allow detailed statistical analysis of factors predicting FN results. Methods: Patients with clinical stage T1-2, N0 invasive breast cancer were enrolled in a prospective, multicenter study. All patients underwent SLN biopsy, followed by planned completion axillary dissection regardless of the SLN results, to assess the FN rate. SLN biopsy was performed using radioactive colloid injection in combination with isosulfan blue dye in 94% of cases. Dermal, subdermal, peritumoral, or subareolar radioactive colloid injection techniques were used at the discretion of each institution. Univariate and multivariate analyses were performed to identify factors associated with a FN result. Results: SLNs were identified in 3870 of 4117 patients (94%). There were 1243 true positive, 2521 true negative, and 106 FN results. Age, histologic subtype, the number of non-SLN removed, tumor palpability, type of breast biopsy, and SLN injection technique were not significant factors. On multivariate analysis, tumor size Ͻ2.5 cm, upper outer quadrant tumor location, removal of only a single SLN, minimal surgeon experience, presence of a single positive axillary LN, and use of immunohistochemistry (IHC) for SLN analysis were independently associated with an increased risk of FN results. Conclusions:Surgeon experience, tumor size and location, and the number of SLN removed are preoperative and intraoperative factors that independently predict the risk of a FN result. In contrast to suggestions from other smaller studies, age does not affect the likelihood of a FN result; a lesser, rather than greater, number of positive axillary nodes was associated with an increased likelihood of a FN result; and IHC analysis of the SLN increases, rather than decreases, the risk of FN results. A lthough sentinel lymph node (SLN) biopsy has become widely accepted as an alternative to routine axillary dissection for breast cancer, the reported false negative (FN) rates have varied widely, from 0% to as high as 19%.1 A FN result could be detrimental to the patient because it results in inaccurate staging, with important implications for adjuvant therapy and the possibility of persistent axillary nodal disease. Previous studies have suggested a variety of factors that may affect the FN rate. However, because FN results are uncommon, no prior study has had a large enough sample size to systematically evaluate factors that are independently associated with FN results. Thus, the purpose of this analysis was to determine, in a large multi-institutional study, the factors that predict FN SLN biopsy results. METHODSThe University of Louisville Breast Cancer Sentinel Lymph Node Study is a prospective, multi-institutional study involving over 300 surgeons, mostly from community general surgery practices...

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Subareolar injection is a better technique for sentinel lymph node biopsy

Cited by 78 publications

References 8 publications

Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy

Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy

Validation of Subareolar and Periareolar Injection Techniques for Breast Sentinel Lymph Node Biopsy

Clinicopathologic Factors Associated With False-Negative Sentinel Lymph-Node Biopsy in Breast Cancer

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