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Single shot lymphoscintigraphy in breast cancer: Effective single tracer sentinel node detection protocol with reduction in procedural pain

Published:February 02, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.01.015

      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

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