Which injections are used in breast cancer lymphoscintigraphy (sentinel lymph node mapping)?

Updated: Dec 13, 2018
  • Author: Durre Sabih, MBBS, MSc, FRCP(Edin); Chief Editor: Mahan Mathur, MD  more...
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Injection techniques can be divided into superficial and deep methods. The superficial techniques include intradermal, subcutaneous, subareolar, and periareolar injections. Deep techniques include peritumoral or intratumoral injections. Subcutaneous, periareolar, and subareolar techniques are associated with a low yield of nonaxillary nodes.

The combination of radiocolloid injection and blue-dye injection immediately before surgery gives the highest sensitivity and specificity of the technique.  However, numerous studies have also found that SLN biopsy with radiotracer alone is successful. [16, 17]  A meta-analysis found that mapping sentinel lymph node locations with methylene blue alone results in an acceptable identification rate but an excessive false-negative rate. [18]

SLN biopsy with near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been reported to be a highly sensitive method for SLN detection. In this method, ICG is injected and then tracked through the lymphatic ducts to SLNs using an excitation illumination system and a high-sensitivity camera. [19]  

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