Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: Technical and kinetic considerations

Frederick L Moffat, Seza A. Gulec, Scott Y. Sittler, Aldo N Serafini, George N Sfakianakis, Jodeen E. Boggs, Dido Franceschi, Christopher S. Pruett, Raoul Pop, Cem Gurkok, Alan Livingstone, David N. Krag

Research output: Contribution to journalArticle

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Abstract

Background: There are few clinical data on technical limitations and radiocolloid kinetics related to sentinel lymph node (SLN) biopsy for breast cancer. Methods: In 70 clinical node-negative patients, unfiltered 99mTc sulfur-colloid was injected peritumorally and cutaneous hot spots were mapped with a gamma probe. SLN biopsy was performed followed by axillary lymph node dissection. Missed radioactive nodes (nodes not under hot spots) were removed from axillary lymph node dissection specimens and submitted separately. Results: At least one hot spot was mapped in 69 patients (98%) and SLNs were retrieved in 62 (89%). No radiolabeled nodes were found in five (7%) and only nodes not under hot spots were retrieved in three patients (4%). Residual nodes not under hot spots were retrieved in 17 patients (24%) in whom at least one SLN specimen had been found. Diffuse radioactivity around the radiocolloid injection site impeded identification of all radiolabeled nodes during SLN biopsy, and was responsible for one of two false negatives (20 node-positive patients; false-negative rate 10%). Hot spot radioactivity, number of radiolabeled nodes, and nodal radioactivity did not change with time interval from radiocolloid injection to surgery (0.75-6.25 hours). Conclusions: Although SLN localization rate is high, intraparenchymal injection may predispose to failure of radiocolloid migration, failure to identify SLNs because of high radiation background, and false-negative outcomes. Alternative routes of radiocolloid administration should be explored.

Original languageEnglish
Pages (from-to)746-755
Number of pages10
JournalAnnals of Surgical Oncology
Volume6
Issue number8
StatePublished - Dec 1 1999

Fingerprint

Colloids
Sulfur
Sentinel Lymph Node Biopsy
Breast Neoplasms
Biopsy
Radioactivity
Lymph Node Excision
Injections
Background Radiation
cyhalothrin
Skin
Sentinel Lymph Node

Keywords

  • Gamma detection probe
  • Radiocolloid
  • Sentinel node biopsy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Moffat, F. L., Gulec, S. A., Sittler, S. Y., Serafini, A. N., Sfakianakis, G. N., Boggs, J. E., ... Krag, D. N. (1999). Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: Technical and kinetic considerations. Annals of Surgical Oncology, 6(8), 746-755.

Unfiltered sulfur colloid and sentinel node biopsy for breast cancer : Technical and kinetic considerations. / Moffat, Frederick L; Gulec, Seza A.; Sittler, Scott Y.; Serafini, Aldo N; Sfakianakis, George N; Boggs, Jodeen E.; Franceschi, Dido; Pruett, Christopher S.; Pop, Raoul; Gurkok, Cem; Livingstone, Alan; Krag, David N.

In: Annals of Surgical Oncology, Vol. 6, No. 8, 01.12.1999, p. 746-755.

Research output: Contribution to journalArticle

Moffat, FL, Gulec, SA, Sittler, SY, Serafini, AN, Sfakianakis, GN, Boggs, JE, Franceschi, D, Pruett, CS, Pop, R, Gurkok, C, Livingstone, A & Krag, DN 1999, 'Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: Technical and kinetic considerations', Annals of Surgical Oncology, vol. 6, no. 8, pp. 746-755.
Moffat, Frederick L ; Gulec, Seza A. ; Sittler, Scott Y. ; Serafini, Aldo N ; Sfakianakis, George N ; Boggs, Jodeen E. ; Franceschi, Dido ; Pruett, Christopher S. ; Pop, Raoul ; Gurkok, Cem ; Livingstone, Alan ; Krag, David N. / Unfiltered sulfur colloid and sentinel node biopsy for breast cancer : Technical and kinetic considerations. In: Annals of Surgical Oncology. 1999 ; Vol. 6, No. 8. pp. 746-755.
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abstract = "Background: There are few clinical data on technical limitations and radiocolloid kinetics related to sentinel lymph node (SLN) biopsy for breast cancer. Methods: In 70 clinical node-negative patients, unfiltered 99mTc sulfur-colloid was injected peritumorally and cutaneous hot spots were mapped with a gamma probe. SLN biopsy was performed followed by axillary lymph node dissection. Missed radioactive nodes (nodes not under hot spots) were removed from axillary lymph node dissection specimens and submitted separately. Results: At least one hot spot was mapped in 69 patients (98{\%}) and SLNs were retrieved in 62 (89{\%}). No radiolabeled nodes were found in five (7{\%}) and only nodes not under hot spots were retrieved in three patients (4{\%}). Residual nodes not under hot spots were retrieved in 17 patients (24{\%}) in whom at least one SLN specimen had been found. Diffuse radioactivity around the radiocolloid injection site impeded identification of all radiolabeled nodes during SLN biopsy, and was responsible for one of two false negatives (20 node-positive patients; false-negative rate 10{\%}). Hot spot radioactivity, number of radiolabeled nodes, and nodal radioactivity did not change with time interval from radiocolloid injection to surgery (0.75-6.25 hours). Conclusions: Although SLN localization rate is high, intraparenchymal injection may predispose to failure of radiocolloid migration, failure to identify SLNs because of high radiation background, and false-negative outcomes. Alternative routes of radiocolloid administration should be explored.",
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T1 - Unfiltered sulfur colloid and sentinel node biopsy for breast cancer

T2 - Technical and kinetic considerations

AU - Moffat, Frederick L

AU - Gulec, Seza A.

AU - Sittler, Scott Y.

AU - Serafini, Aldo N

AU - Sfakianakis, George N

AU - Boggs, Jodeen E.

AU - Franceschi, Dido

AU - Pruett, Christopher S.

AU - Pop, Raoul

AU - Gurkok, Cem

AU - Livingstone, Alan

AU - Krag, David N.

PY - 1999/12/1

Y1 - 1999/12/1

N2 - Background: There are few clinical data on technical limitations and radiocolloid kinetics related to sentinel lymph node (SLN) biopsy for breast cancer. Methods: In 70 clinical node-negative patients, unfiltered 99mTc sulfur-colloid was injected peritumorally and cutaneous hot spots were mapped with a gamma probe. SLN biopsy was performed followed by axillary lymph node dissection. Missed radioactive nodes (nodes not under hot spots) were removed from axillary lymph node dissection specimens and submitted separately. Results: At least one hot spot was mapped in 69 patients (98%) and SLNs were retrieved in 62 (89%). No radiolabeled nodes were found in five (7%) and only nodes not under hot spots were retrieved in three patients (4%). Residual nodes not under hot spots were retrieved in 17 patients (24%) in whom at least one SLN specimen had been found. Diffuse radioactivity around the radiocolloid injection site impeded identification of all radiolabeled nodes during SLN biopsy, and was responsible for one of two false negatives (20 node-positive patients; false-negative rate 10%). Hot spot radioactivity, number of radiolabeled nodes, and nodal radioactivity did not change with time interval from radiocolloid injection to surgery (0.75-6.25 hours). Conclusions: Although SLN localization rate is high, intraparenchymal injection may predispose to failure of radiocolloid migration, failure to identify SLNs because of high radiation background, and false-negative outcomes. Alternative routes of radiocolloid administration should be explored.

AB - Background: There are few clinical data on technical limitations and radiocolloid kinetics related to sentinel lymph node (SLN) biopsy for breast cancer. Methods: In 70 clinical node-negative patients, unfiltered 99mTc sulfur-colloid was injected peritumorally and cutaneous hot spots were mapped with a gamma probe. SLN biopsy was performed followed by axillary lymph node dissection. Missed radioactive nodes (nodes not under hot spots) were removed from axillary lymph node dissection specimens and submitted separately. Results: At least one hot spot was mapped in 69 patients (98%) and SLNs were retrieved in 62 (89%). No radiolabeled nodes were found in five (7%) and only nodes not under hot spots were retrieved in three patients (4%). Residual nodes not under hot spots were retrieved in 17 patients (24%) in whom at least one SLN specimen had been found. Diffuse radioactivity around the radiocolloid injection site impeded identification of all radiolabeled nodes during SLN biopsy, and was responsible for one of two false negatives (20 node-positive patients; false-negative rate 10%). Hot spot radioactivity, number of radiolabeled nodes, and nodal radioactivity did not change with time interval from radiocolloid injection to surgery (0.75-6.25 hours). Conclusions: Although SLN localization rate is high, intraparenchymal injection may predispose to failure of radiocolloid migration, failure to identify SLNs because of high radiation background, and false-negative outcomes. Alternative routes of radiocolloid administration should be explored.

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KW - Radiocolloid

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