Highlights
- •A single radioisotope injection is sufficient for lymphoscintigraphic mapping, achieving improved patient experience with decreased patient discomfort.
- •An optimal sentinel node localization procedure includes a single site periareolar subdermal injection, small needle (26-gauge) with a tuberculin syringe, dose 37 MBq (1 mCi) per breast, volume (0.1 mL), particle size (100-200 nm) and the liberal use of topical anesthetic spray.
Abstract
Purpose
Variation in protocols for axillary sentinel lymph node (SLN) mapping exists. We strive
to evaluate the effectiveness of reduction in number of injections on reducing procedural
pain, while maintaining nodal detection.
Methods
Over 7 years, the number of periareolar injections performed was reduced stepwise
from 4 to 1. This was analyzed for SLN detection and patients' subjective perceived
pain.
Results
828 patients with invasive breast cancer who underwent SLN mapping were included.
Laterality of breast injection site included 326 (39.4%) in the right breast, 354
(42.8%) in the left breast and 148 (17.9%) in bilateral breasts. In patients who had
4 injection sites in a unilateral breast (n = 143), the reported pain score was 4.3 ± 2.4.
Patients with 3 injections (n = 163), 2 injections (n = 163) and 1 injection (n = 211)
in a breast reported pain scores of 3.4 ± 2.4, 3.2 ± 2.2, and 2.9 ± 2.6, respectively.
In patients who had bilateral sentinel node procedures, those with 4 injections in
each breast for a total of 8 injections (n = 37) reported a pain score of 5.7 ± 2.4.
Patients with 3 (n = 51), 2 (n = 31) and 1 (n = 39) injection(s) in each breast reported
perceived pain of 4.8 ± 2.8, 3.7 ± 2.7 and 3.5 ± 1.9, respectively. Incremental decreased
pain scores were achieved with decreasing number of injections (p < 0.001). Nodal
detection was maintained.
Conclusion
A single periareolar subdermal injection site reduces periprocedural pain while maintaining
nodal detection.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol. 2005; 23: 7703-7720
- Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.Lancet. 1997; 349: 1864-1867
- Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized controlled trial.JAMA. 2011; 305: 569-575
- Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial.JAMA. 2017; 318: 918-926
- Imaging-based approach to axillary lymph node staging and sentinel lymph node biopsy in patients with breast cancer.Am J Roentgenol. 2020; 214: 249-258
- The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer.Eur J Nucl Med Mol Imaging. 2013; 40: 1932-1947
- Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer.J Nucl Med. 1998; 39: 2080-2084
- Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection.J Am Coll Surg. 1998; 186: 275-283
- Subareolar versus peritumoral injection for location of the sentinel lymph node.Ann Surg. 1999; 229: 860-864
- Sentinel node mapping for breast cancer: current situation.J Oncol. 2012; 36134https://doi.org/10.1155/2012/36134
- Diagnostic accuracy of sentinel node identification is maintained with the addition of local lidocaine and subareolar radioactive colloid injection.Breast Cancer Res Treat. 2015; 150: 589-595
- Sentinel node biopsy in breast cancer.Bull Cancer. 2009; 96: 713-725
- Clinical breast lymphoscintigraphy: optimal techniques for performing studies, image atlas, and analysis of images.Radiographics. 2004; 24: 121-145
- Radioguided sentinel lymph node biopsy in breast cancer surgery.J Nucl Med. 2001; 42: 1198-1215
- Desirable properties of radiopharmaceuticals for sentinel node mapping in patients with breast cancer given the paradigm shift in patient management.Clin Nucl Med. 2017; 42: 275-279
- The combination of blue dye and radioisotope versus radioisotope alone during sentinel lymph node biopsy for breast cancer: a systematic review.BMC Cancer. 2016; 16https://doi.org/10.1186/s12885-016-2137-0
- The value of isosulfan blue dye in addition to isotope scanning in the identification of the sentinel lymph node in breast cancer patients with a positive lymphoscintigraphy: a randomized controlled trial (ISRCTN98849733).Ann Surg. 2015; 262: 243-248
- Limited effectiveness of patent blue dye in addition to isotope scanning for identification of sentinel lymph nodes: cross-sectional real-life study in 1024 breast cancer patients.Int J Surg. 2016; 33: 177-181
- The use of periareolar topical lidocaine jelly after needle localization may reduce pain of subsequent lymphoscintigraphy.Cureus. 2020; 12e7861
- Administration of subcutaneous buffered lidocaine prior to breast lymphoscintigraphy reduces pain without decreasing lymph node visualization.J Nucl Med Technol. 2014; 42: 260-264
- Buffering the suffering of breast lymphoscintigraphy.J Nucl Med Technol. 2020; 48: 51-53
- Relieving the pain of sentinel lymph node biopsy tracer injection.Clin J Oncol Nurs. 2008; 12: 668-670
Article info
Publication history
Published online: February 02, 2022
Accepted:
January 26,
2022
Received in revised form:
January 8,
2022
Received:
October 11,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
