Use of radiotracer for sentinel lymph node mapping in breast cancer optimizes staging independent of site of administration

Susan B. Kesmodel, Robert J. Canter, Kyla P. Terhune, Todd W. Bauer, Rosemarie Mick, Ernest F. Rosato, Francis R. Spitz, Douglas L. Fraker, Abass Alavi, Brian J. Czerniecki

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


PURPOSE: In an effort to optimize sentinel lymph node (SLN) mapping for breast cancer, sites of mapping agent administration and types of mapping agents used continue to be evaluated. This study compares SLN mapping using peritumoral (PT) or subareolar (SA) injection of radiolabeled colloid and examines the relative contributions of radiotracer and blue dye to SLN identification. MATERIALS AND METHODS: A retrospective review was performed of 456 patients with breast cancer and clinically negative axillae who underwent SLN mapping. Sequential groups of patients were injected with filtered Tc-99m SC, 326 peritumorally (group 1) and 130 subareolarly (group 2). All patients had intraoperative SA injection of 1% isosulfan blue dye. RESULTS: The SLN identification and isotope success rates were 97% and 96% in group 1 and 98% and 98% in group 2, respectively. Eighty-one patients (25%) in group 1 and 44 patients (34%) in group 2 had positive SLNs. Of these patients, 15% from group 1 and 14% from group 2 had only positive nodes detected by radiotracer, and 9 of these patients (6 from group 1 and 3 from group 2) had other nodes identified by both radiotracer and blue dye that were negative for metastases. Six percent of patients with positive SLNs were upstaged because of use of radiotracer. CONCLUSIONS: PT and SA injection of radiotracer have comparable success rates for axillary SLN identification. Given that 15% of patients in group 1 and 14% in group 2 had only positive SLNs detected by radiotracer, independent of site of administration, radiotracer remains essential for optimizing breast SLN mapping.

Original languageEnglish (US)
Pages (from-to)527-533
Number of pages7
JournalClinical nuclear medicine
Issue number9
StatePublished - Sep 2006
Externally publishedYes


  • Breast cancer
  • Peritumoral
  • Radiotracer
  • Sentinel lymph node mapping
  • Subareolar

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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