Intradermal radioisotope is superior to peritumoral blue dye or radioisotope in identifying breast cancer sentinel nodes

J Am Coll Surg. 2004 Oct;199(4):561-6. doi: 10.1016/j.jamcollsurg.2004.06.018.


Background: Sentinel lymph node (SLN) mapping and biopsy have emerged as the technique of choice for axillary staging of breast cancer. Several methods have been developed to identify SLNs, including peritumoral or intradermal injection of isosulfan blue dye or technetium sulfur colloid (TSC). We hypothesize that intradermal TSC is the optimal mapping technique and can be used alone to identify SLNs.

Study design: From March 1997 through January 2001, 180 women with T1 and T2 invasive breast cancer and clinically negative axilla underwent SLN mapping and biopsy. Peritumoral TSC was injected in 74 patients, 62 of whom also received peritumoral blue dye. Intradermal TSC (above tumor) was performed in 94 patients, 76 of whom also received peritumoral blue dye. Technetium-rich nodes were identified intraoperatively using a hand-held gamma probe and blue nodes were identified visually. Hematoxylin- and eosin-stained SLN sections were examined by light microscopy for breast cancer metastases.

Results: Overall, the SLN mapping procedures were successful in 91% of patients. Peritumoral and intradermal TSC were successful in identifying SLNs in 78% and 97% of patients, respectively. Peritumorally injected isosulfan blue was successful in identifying 83% of SLNs. Intradermal TSC was found to be superior to peritumoral TSC and peritumoral blue dye in identifying SLNs (p = 0.00094, chi-squared, and p = 0.020, ANOVA).

Conclusions: SLN mapping by intradermal TSC has a significantly higher success rate than peritumoral TSC or blue dye. There was minimal benefit in identifying additional SLNs with addition of peritumoral blue dye to intradermal TSC. So, SLN mapping and biopsy using intradermal-injected TSC can be used alone to effectively stage the axilla for breast cancer.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Breast Neoplasms / pathology*
  • Coloring Agents / administration & dosage*
  • Female
  • Humans
  • Injections, Intradermal
  • Injections, Intralesional
  • Lymphatic Metastasis
  • Neoplasm Staging
  • Radioisotopes / administration & dosage*
  • Radiopharmaceuticals / administration & dosage*
  • Rosaniline Dyes / administration & dosage*
  • Sentinel Lymph Node Biopsy / methods*
  • Technetium Tc 99m Sulfur Colloid / administration & dosage*


  • Coloring Agents
  • Radioisotopes
  • Radiopharmaceuticals
  • Rosaniline Dyes
  • iso-sulfan blue
  • Technetium Tc 99m Sulfur Colloid