Immediate dynamic lymphoscintigraphy delivers no additional value to lymphoscintigraphy 3 hr after tracer injection in sentinel lymph node biopsy in breast cancer patients

Objective Immediate dynamic imaging enables accurate definition of sentinel lymph nodes, whereas imaging 3 hr after tracer injection may lead to overestimation of the number of sentinel lymph nodes. A study was performed to define the value of lymphoscintigraphy immediately versus 3 hr after tracer injection in sentinel lymph node biopsy for breast cancer management. Methods In 165 sentinel lymph node biopsy procedures preoperative immediate and 3 hr post‐injection lymphoscintigraphy was performed after intraparenchymal tracer administration. Results Lymph node visualization occurred in 63 immediate procedures (38%) versus in 163 procedures 3 hr post‐injection (99%). In 17 procedures (10%) in which immediate lymphoscintigraphy had visualized sentinel lymph nodes, additional nodes had been seen on 3 hr post‐injection lymphoscintigraphy. In eight of these procedures (5%) all nodes were detected in the same draining lymph node basin. Non‐axillary sentinel lymph nodes were identified by preoperative lymphoscintigraphy in 28 procedures (17%) and improved staging in three patients (5%). Conclusion The only impact of immediate lymphoscintigraphy was the possible omission of removal of 1–2 sec‐echelon nodes per patient in 5% of patients. We consider this yield too low to continue immediate lymphoscintigraphy in breast cancer patients. J. Surg. Oncol. 2007;95:469–475. © 2006 Wiley‐Liss, Inc.