PMID- 11266281
OWN - NLM
STAT- MEDLINE
DCOM- 20010503
LR  - 20151119
IS  - 0022-4804 (Print)
IS  - 0022-4804 (Linking)
VI  - 96
IP  - 2
DP  - 2001 Apr
TI  - Comparison of intradermal and subcutaneous injections in lymphatic mapping.
PG  - 255-9
AB  - BACKGROUND: Sentinel node biopsy (SNB) for melanoma, with its intradermal (ID) 
      injection, has a higher success rate than SNB for breast cancer, which is 
      typically performed with a subcutaneous (SC) or peritumor injection. It is 
      hypothesized that this is in part due to a slower transit time of lymphatic 
      mapping agents through the parenchymal lymphatics of the breast. No study has 
      investigated differences in transit time between different tissues to account for 
      this clinical observation. The goal of the study was to compare transit time 
      between ID and SC injections with common agents used in lymphatic mapping. 
      METHODS: Four injection sites on five domestic pigs were used. Sites were 
      bilateral and included cervical, forelimb, hindlimb, and flank areas. Agents 
      included technetium sulfur colloid (Tc99, filtered and unfiltered), isosulfan 
      blue (IB) dye, and fluorescein (FL) dye. At each site both ID and SC injections 
      were made and the transit time to reach the sentinel node was recorded. The 
      transit time differences were calculated per centimeter distance from the 
      draining lymph node basin. RESULTS: Sentinel nodes were identified draining all 
      sites and found to be hot, blue, or fluorescent (using a Wood's lamp for 
      identification). The cervical and forelimb injection sites drained to the same 
      cervical lymph node basin and both SC and ID injection sites drained to the same 
      sentinel node. Similarly, the hindlimb and flank injection sites both drained to 
      inguinal lymph node basins. The slowest transit time occurred with Tc99 injected 
      SC and the fastest occurred with Tc99 injected ID, whereas both FL dye and IB 
      traveled rapidly to the sentinel node whether injected SC or ID. Large 
      differences were found using unfiltered Tc99 depending on its injection ID (2.7 
      s/cm +/- 0.5) vs SC (249 s/cm +/- 14.7, P = 0.008). CONCLUSIONS: Tc99 ID 
      injections were significantly faster than SC injection. The slowest and fastest 
      SC injection agents were unfiltered Tc99 and IB, respectively. Dermal injections 
      provide faster transit of lymphatic agents and may improve the identification 
      rate when applied to patients with breast cancer.
CI  - Copyright 2001 Academic Press.
FAU - Kersey, T W
AU  - Kersey TW
AD  - The Breast Center, Anne Arundel Medical Center, Annapolis, Maryland 21401, USA.
FAU - Van Eyk, J
AU  - Van Eyk J
FAU - Lannin, D R
AU  - Lannin DR
FAU - Chua, A N
AU  - Chua AN
FAU - Tafra, L
AU  - Tafra L
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
RN  - 0 (Contrast Media)
RN  - 0 (Radiopharmaceuticals)
RN  - 0 (Rosaniline Dyes)
RN  - 39N9K8S2A4 (iso-sulfan blue)
RN  - 556Q0P6PB1 (Technetium Tc 99m Sulfur Colloid)
RN  - TPY09G7XIR (Fluorescein)
SB  - IM
MH  - Animals
MH  - Contrast Media/*administration & dosage/pharmacokinetics
MH  - Fluorescein/*administration & dosage/pharmacokinetics
MH  - Injections, Intradermal
MH  - Injections, Subcutaneous
MH  - Lymph/*metabolism
MH  - Lymph Nodes/*metabolism
MH  - Radiopharmaceuticals/*administration & dosage/pharmacokinetics
MH  - Rosaniline Dyes/*administration & dosage/pharmacokinetics
MH  - Swine
MH  - Technetium Tc 99m Sulfur Colloid/*administration & dosage/pharmacokinetics
MH  - Time Factors
EDAT- 2001/03/27 10:00
MHDA- 2001/05/05 10:01
CRDT- 2001/03/27 10:00
PHST- 2001/03/27 10:00 [pubmed]
PHST- 2001/05/05 10:01 [medline]
PHST- 2001/03/27 10:00 [entrez]
AID - S0022-4804(00)96075-X [pii]
AID - 10.1006/jsre.2000.6075 [doi]
PST - ppublish
SO  - J Surg Res. 2001 Apr;96(2):255-9. doi: 10.1006/jsre.2000.6075.