Injection technique

The various injection techniques include intraparenchymal, dermal or subdermal, and subareolar. All three techniques have been shown to be reliable in experienced hands. The dermal technique has been shown by McMasters et al. (20) to identify the SLN in the axilla with increased frequency as compared to the peritumoral injection technique (98% vs. 90%). The dermal technique (Figure 3) results in significantly higher counts in the SLN and compares favourably with the peritumoral injection for concordance and false negatives. The subareolar technique offers many of the advantages of the dermal injection: it is easy, avoids the need for image guided injection, and increases the distance of the tumour from the axillary SLN thus eliminating shine through from upper outer quadrant lesions. The transit time is also quicker than the peritumoral technique (21). In spite of the many advantages of the dermal or subareolar technique, some institutions continue to utilise an intraparenchymal injection, because this is the only technique that will identify internal mammary lymph nodes.

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