Intraoperative Lymphatic Mapping Using A Radiolabeled Colloid

Krag et al. published the first pilot study of sentinel lymphadenectomy in patients with invasive breast cancer [23]. In this study, an unfiltered technetium-99m (99mTc)-labeled colloid was injected 1-9 h prior to surgery and was used to map the lymphatic tract and identify the sentinel node. The sentinel node was identified in 82% of a group of 22 patients using a hand-held gamma-ray counter. The sentinel node proved 100% predictive of the axillary status. This implies that if this node is free of disease, the remainder of the axillary nodes are also free of disease. Krag and co-workers updated their results in 248 cases [24]. The sentinel node was identified in 95.5% of patients with a false-negative rate of 6.5%. This led to the initiation of a multicenter trial to evaluate the success of intraoperative lymphatic mapping and sentinel lymphadenectomy using a radiolabeled colloid. The results of this trial have recently been reported and show a false-negative sentinel lymph node biopsy rate of 11.4% in a multicenter trial involving 12 institutions [25].

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