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Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):486-490
DOI 10.1590/S0100-72032010001000003
PURPOSE: to determine the efficacy of intraoperative injection of Dextran-500-99m-technetium (Tc) for the identification of the sentinel lymph node (SLN) in breast cancer and analyze time to label the SLN in the axillary region. METHODS: a prospective study between April 2008 and June 2009, which included 74 sentinel lymph node biopsies (SLNB) in patients with breast cancer in stages T1N0 and T2N0. After induction of anesthesia, 0.5 to 1.5 mCi of Dextran-500-99m-Tc filtered 0.22 µm in a volume of 5 mL was injected intraoperative using the subareolar technique for SLNB. After labeling with the radioisotope, 2 mL of patent blue was injected. The time elapsed between injection and the axillary hot spot, the in vivo and ex vivo counts of the hottest nodes, the background count, and the number of SLN identified were documented. Data were analyzed using descriptive statistics with SPSS program, version 18. RESULTS: we identified the SLN in 100% of cases. The rate of SLN identification with the probe was 98% (73/74 cases). In one case (1.35%) the SLN was labeled only with the blue dye. The mean dose of radioisotope injected was 0.97±0.22 mCi. The average time to label the SLN was 10.7 minutes (±5.7 min). We identified on average of 1.66 SLN labeled with the radioisotope. CONCLUSION: the procedure for SLN identification with an intraoperative injection of the radioisotope is oncologically safe and comfortable for the patient, providing agility to the surgical team.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):486-490
DOI 10.1590/S0100-72032010001000003
PURPOSE: to determine the efficacy of intraoperative injection of Dextran-500-99m-technetium (Tc) for the identification of the sentinel lymph node (SLN) in breast cancer and analyze time to label the SLN in the axillary region. METHODS: a prospective study between April 2008 and June 2009, which included 74 sentinel lymph node biopsies (SLNB) in patients with breast cancer in stages T1N0 and T2N0. After induction of anesthesia, 0.5 to 1.5 mCi of Dextran-500-99m-Tc filtered 0.22 µm in a volume of 5 mL was injected intraoperative using the subareolar technique for SLNB. After labeling with the radioisotope, 2 mL of patent blue was injected. The time elapsed between injection and the axillary hot spot, the in vivo and ex vivo counts of the hottest nodes, the background count, and the number of SLN identified were documented. Data were analyzed using descriptive statistics with SPSS program, version 18. RESULTS: we identified the SLN in 100% of cases. The rate of SLN identification with the probe was 98% (73/74 cases). In one case (1.35%) the SLN was labeled only with the blue dye. The mean dose of radioisotope injected was 0.97±0.22 mCi. The average time to label the SLN was 10.7 minutes (±5.7 min). We identified on average of 1.66 SLN labeled with the radioisotope. CONCLUSION: the procedure for SLN identification with an intraoperative injection of the radioisotope is oncologically safe and comfortable for the patient, providing agility to the surgical team.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):340-346
DOI 10.1590/S0100-72032005000600008
PURPOSE: a case-control study comparing two radiocolloids used in scintigraphy to map the sentinel lymph nodes (SLN) in breast cancer patients. METHODS: forty patients were prospectively enrolled between May 2002 and April 2004, after signing an informed consent form. In the present double-blind study, each patient was submitted twice to the same examination, a mammary scintigraphy, one with 99mTc-dextran 500 (dextran) and the other with 99mTc-phytate (phytate), on different days. A volume of 2 ml with 1-1.5 mCi of each radiopharmaceutical, in divided aliquots, was injected in the breast parenchyma in four points around in the tumor and the subcutaneous area superficial to the tumor. The image was obtained 2 h after the injection, using a gamma camera with high-resolution collimator. The lymph nodes were identified by anterior and lateral static scintigraphic images. Statistical analysis was done with the use of McNemar and Z tests. RESULTS: in the analysis of the 40 patients, we had 15 pairs with positive identical images, 4 pairs with negative images and 21 pairs with inconsistent images, either because one of them was negative, or because the SLN numbers were different. When the protocol was opened, we found 35 and 27 positive images and 5 and 13 negative images for dextran and phytate treatment groups, respectively. Among the negative images, 4 were shared by both groups. The McNemar test, used for the statistical analysis, showed p=0.026, odds ratio (OR) = 0.11 with 95% CI 0.01 < OR < 0.85. The accuracy, evaluated by the success ratio of the SLN mapping, was 67.5% for phytate and 87.5% for dextran, with p=0.032. Analysis of variance of the SLN number in lymphoscintigraphy images showed p=0.008. CONCLUSION: these results recommend the use of dextran instead of phytate for the SLN study of breast carcinoma by scintigraphy, when the same methodology is being used.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(6):340-346
DOI 10.1590/S0100-72032005000600008
PURPOSE: a case-control study comparing two radiocolloids used in scintigraphy to map the sentinel lymph nodes (SLN) in breast cancer patients. METHODS: forty patients were prospectively enrolled between May 2002 and April 2004, after signing an informed consent form. In the present double-blind study, each patient was submitted twice to the same examination, a mammary scintigraphy, one with 99mTc-dextran 500 (dextran) and the other with 99mTc-phytate (phytate), on different days. A volume of 2 ml with 1-1.5 mCi of each radiopharmaceutical, in divided aliquots, was injected in the breast parenchyma in four points around in the tumor and the subcutaneous area superficial to the tumor. The image was obtained 2 h after the injection, using a gamma camera with high-resolution collimator. The lymph nodes were identified by anterior and lateral static scintigraphic images. Statistical analysis was done with the use of McNemar and Z tests. RESULTS: in the analysis of the 40 patients, we had 15 pairs with positive identical images, 4 pairs with negative images and 21 pairs with inconsistent images, either because one of them was negative, or because the SLN numbers were different. When the protocol was opened, we found 35 and 27 positive images and 5 and 13 negative images for dextran and phytate treatment groups, respectively. Among the negative images, 4 were shared by both groups. The McNemar test, used for the statistical analysis, showed p=0.026, odds ratio (OR) = 0.11 with 95% CI 0.01 < OR < 0.85. The accuracy, evaluated by the success ratio of the SLN mapping, was 67.5% for phytate and 87.5% for dextran, with p=0.032. Analysis of variance of the SLN number in lymphoscintigraphy images showed p=0.008. CONCLUSION: these results recommend the use of dextran instead of phytate for the SLN study of breast carcinoma by scintigraphy, when the same methodology is being used.
