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Intraoperative Injection of 99m-Technetium Sulfur Colloid for Breast Sentinel Lymph Node Biopsy
Dalliah Black1, Baiba Grube1, Teresa Ponn2, Donald Lannin1
1Yale School of Medicine, New Haven, CT;2Eliot Breast Center, Manchester, NH

Objective: Assess the feasibility, identification rate, and outcome of intraoperative injection of 99-m technetium sulfur colloid for breast sentinel lymph node biopsy (SLNB).
Design: Retrospective review of SLNB procedures.
Setting: University based breast center with four dedicated breast surgeons.
Patients: From July 2002 to December 2006, 554 SLNBs were performed using intraoperative injection.
Intervention: 0.25 millicurie of 99m-technetium sulfur colloid was injected intraoperatively after the patient was anesthetized. The radioactive tracer was infiltrated intradermally as a skin wheal directly over the breast cancer site. Hot SLNs deep to the axillary fascia were identified with the gamma counter and submitted to pathology for analysis.
Main Outcome Measure: The number of cases with successful axillary mapping was determined.
Results: 553 of 554 (>99%) cases had successful mapping with tracer activity in at least one axillary lymph node, and the mean number of sentinel nodes found was 2.1 per patient (range 1-7). One hundred twenty-nine patients (23%) had SLNs positive for breast cancer metastasis and underwent ALND. In 57% of these cases, only SLNs were involved, but 25% had spread to 1-3 non-sentinel nodes and 18% had involvement of 4 or more non-sentinel nodes. Subjective benefits of intraoperative injection include: SLNB can be a first case, the injection was not painful for the patient, and it was logistically easier for the patient and operating room scheduling since both the injection and surgery were performed in one location.
Conclusion: Intraoperative injection of 99m-technetium sulfur colloid into the breast is an excellent method for mapping and biopsing axillary SLNs. Its advantages, including no patient discomfort or operating room delays, make it an attractive alternative to traditional preoperative injection techniques.


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