Injection Site Critical For SNB

ASBD: Studies Suggest Injection Site Is Critical to Success of Sentinel Node Biopsy"

A pair of studies presented here at the American Society of Breast Disease 28th Annual Symposium suggest that sentinel node biopsy can be successfully performed in the community setting, but only if techniques are adapted to meet diverse populations.

The two studies from researchers at the Eastern Virginia School of Medicine Department of Surgery and from clinicians at the Kapi'olani Breast Center, Honolulu, Hawaii, illustrate some of the pitfalls of sentinel node biopsy, said Alison Estabrook, MD, professor of clinical surgery, Columbia-Presbyterian Medical Center, New York.

"These are important studies in that sentinel node can be difficult to do in the community setting,and these studies suggest some ways around that difficulty," Dr. Estabrook said in an interview. She was not involved in the studies but was a discussant during the poster session.

"The Virginia researchers reported that they had difficulty finding the sentinel node in African-American women," Dr. Estabrook said. But during the discussion period, she pointed out that this difficulty might be overcome by changing the injection technique.

"If you inject intradermally, that should work because the skin is rich in lymphatics. On the other hand, if one injects into the breast, there is a great deal of fat in the breast and that is why the contrast does not get to the node."

In the Virginia study the false-negative rate was 0.9% for white women and 9% for African-American women. In the study from Hawaii, body mass index (BMI) predicted blue dye failure.

"Since failures were more common in obese women, this suggests that body size is a factor. But here, too, an intradermal injection -- rather than injecting into the breast -- should overcome this problem," Dr. Estabrook said.

In the study from Hawaii, Laura Weldon Hoque, MD and colleagues write, "[S]entinel nodes were successfully identified and excised in all patients.

There were 4 isotope failures 16 blue dye failures and 0 false-positives. Blue dye failure was associated with higher BMI (P < .05). Seventy-seven patients had positive nodes and 84% of these had no further axillary metastases.

Native Hawaiian women were more likely to be overweight (P < .05)." Two hundred and four patients with T1-T2NO breast cancer were enrolled in the Hawaiian study while 69 African-American and 154 Caucasian women were included in the study conducted by Stephen Becker, MD, and colleagues, Eastern Virginia School of Medicine, Norfolk, Virginia.

[Presentation titles: "Racial Disparities in the Era of Sentinel Lymph Node (SLN) Biopsy for Breast Cancer." Poster #15, and "Establishing Sentinel Lymph Node Biopsy in a Community Setting: Perspectives From Hawaii." Poster #16]

By Peggy Peck, www.docguide.com

Ann's NOTE: I would imagine skin color would make a difference in seeing the blue dye. This is not mentioned in the study but in the darker skin women, it may be a factor. We will try to ask the authors.

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