The effects of postinjection massage on the sensitivity of lymphatic mapping in breast cancer

BACKGROUND: The technique of lymphatic mapping and sentinel lymph node (SLN ) biopsy is rapidly becoming the preferred method of staging the axilla of the breast cancer patient. This report describes the impact of postinjectio n massage on the sensitivity of this surgical technique. STUDY DESIGN: Lymphatic mapping at the H Lee Moffitt Cancer Center is perfo rmed using a combination of isosulfan blue dye and Tc-99m labeled sulfur co lloid. Data describing the rate of SLN identification and the node characte ristics from 594 consecutive patients were calculated. Patients who receive d a 5-minute massage after injection of blue dye and radiocolloid were comp ared with a control group in which the patients did not receive a postinjec tion massage. RESULTS: When compared with controls, the proportion of patients who had th eir SLN identified using blue dye after massage increased from 73.0% to 88. 3%, and the proportion of patients who had their SLN identified using radio colloid after massage increased from 81.7% to 91.3%. The overall rate of SL N identification increased from 93.5% to 97.8%. The proportion of nodes tha t were stained blue among those removed increased from 73.4% to 79.7% after massage. CONCLUSIONS: As experience increases with this new procedure, the surgical technique of lymphatic mapping continues to evolve. The addition of a posti njection massage significantly improves the uptake of blue dye by SLNs and may also aid in the accumulation of radioactivity in the SLNs, further incr easing the sensitivity of this procedure. (J Am Coll Surg 2001;192:9-16. (C ) 2001 by the American College of Surgeons).