Intraoperative radioisotope injection for sentinel lymph node biopsy.

Background: Preoperative injection of technetium-99 m sulfur colloid (Tc-99) in the Nuclear Medicine Department for localizing sentinel lymph nodes (SLNs) can be extremely painful for the patient. The difficulties in scheduling and the delay in starting surgery can be frustrating for the patient and the surgeon. We hypothesized that intraoperative injection facilitated by the subareolar technique would obviate the problems associated with preoperative injection.

Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation.

Background: Variations in arm lymphatic drainage put the arm lymphatics at risk for disruption during axillary lymph node surgery. Mapping the drainage of the arm with blue dye (axillary reverse mapping, ARM) decreases the likelihood of disruption of lymphatics and subsequent lymphedema.

Methods: This institutional review board (IRB)-approved study from May to October 2006 involved patients undergoing SLNB and/or ALND.