technetium-tc-99m-sulfur-colloid and Pain

Injection of Tc99m to localize nodes for sentinel lymph node biopsy is reported by patients as very painful. The purpose of this study was to determine if anesthetic cream reduces pain associated with periareolar injection of Tc99m and to help elucidate conflicting literature regarding the efficacy of anesthetic cream for this procedure.. A randomized, double-blind, placebo-controlled methodology was used for adult females with breast cancer undergoing periareolar injection of Tc99m for sentinel lymph node biopsy. Pain levels were compared using anesthetic cream (2.5% lidocaine/2.5% prilocaine) vs. placebo. Patient exclusion criteria included use of opioids or adjuvant pain medication or injecting Tc99m the day before surgery. The Numerical Rating Scale was used to assess pain levels immediately after the injections.. Comparing 23 experimental and 26 control patients, there was no significant difference between the experimental (median = 4) and the control group (median = 5) on level of pain experienced U= 0.492, P > .05.. The experimental group had a slightly lower median pain score; however, there was no statistically significant difference between those who used the cream compared with those who used a placebo, supporting the conclusion that anesthetic cream does not reduce pain during Tc99m injections. This study adds to the current literature to provide a stronger position that there is no benefit to using anesthetic cream for this procedure.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Breast Neoplasms; Double-Blind Method; Female; Humans; Injections; Lymphatic Metastasis; Middle Aged; Ointments; Pain; Pain Measurement; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

The aim of this study was to quantify the reduction of perceived pain levels during lymphoscintigraphy for melanoma by altering the pH of the Tc-sulfur colloid to near the physiologic value of 7.40.. This is an institutional review board- and Food and Drug Administration-approved randomized, double-blinded, prospective crossover trial, registered with clinicaltrials.org. Before beginning the procedure and after signing informed consent, 60 serial enrollees presenting for sentinel lymph node imaging of melanoma of the thorax and appendicular structures completed a questionnaire addressing background information, administered by a research support nurse.An investigator (N.H.) prepared the injections to be used and labeled them such that no one else could discover which injections contained standard-of-care solution and which contained the pH-altered solution (buffered to near pH 7.40 using sodium bicarbonate).After each injection, the enrollee was asked by a research support nurse to quantify the pain of each injection using a scale of 0 to 10. The injection site location (head, thorax, appendicular structures, and other) was also recorded.. Sixty subjects were enrolled in the study, of which 57 had complete data. On average, there was a significant mean (SD) decrease of 1.42 (2.17) points (95% confidence interval, 0.85-2.00) on a pain scale of 0 to 10 when the buffered injections were used as compared with the standard-of-care injections (P < 0.0001). Ordering of injections did not significantly affect perceived pain scores.. The use of sodium bicarbonate to buffer the pH of Tc-sulfur colloid to near the physiologic value of 7.40 significantly reduced perceived pain levels during nonbreast lymphoscintigraphy.

Topics: Adult; Female; Humans; Injections; Lymphoscintigraphy; Male; Melanoma; Middle Aged; Pain; Pain Management; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

No prior studies have examined injection pain associated with Technetium-99m Tilmanocept (TcTM).. This was a randomized, double-blinded study comparing postinjection site pain between filtered Technetium Sulfur Colloid (fTcSC) and TcTM in breast cancer lymphoscintigraphy. Pain was evaluated with a visual analogue scale (VAS) (0-100 mm) and the short-form McGill Pain Questionnaire (SF-MPQ). The primary endpoint was mean difference in VAS scores at 1-min postinjection between fTcSC and TcTM. Secondary endpoints included a comparison of SF-MPQ scores between the groups at 5 min postinjection and construction of a linear mixed effects model to evaluate the changes in pain during the 5-min postinjection period.. Fifty-two patients underwent injection (27-fTcSC, 25-TcTM). At 1-min postinjection, patients who received fTcSC experienced a mean change in pain of 16.8 mm (standard deviation (SD) 19.5) compared with 0.2 mm (SD 7.3) in TcTM (p = 0.0002). At 5 min postinjection, the mean total score on the SF-MPQ was 2.8 (SD 3.0) for fTcSC versus 2.1 (SD 2.5) for TcTM (p = 0.36). In the mixed effects model, injection agent (p < 0.001), time (p < 0.001) and their interaction (p < 0.001) were associated with change in pain during the 5-min postinjection period. The model found fTcSC resulted in significantly more pain of 15.2 mm (p < 0.001), 11.3 mm (p = 0.001), and 7.5 mm (p = 0.013) at 1, 2, and 3 min postinjection, respectively.. Injection with fTcSC causes significantly more pain during the first 3 min postinjection compared with TcTM in women undergoing lymphoscintigraphy for breast cancer.

Topics: Breast Neoplasms; Dextrans; Double-Blind Method; Female; Follow-Up Studies; Humans; Lymph Nodes; Lymphoscintigraphy; Mannans; Middle Aged; Neoplasm Staging; Pain; Prognosis; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

A practice standard in sentinel lymph node (SLN) mapping in breast cancer is intradermal injection of technetium-99m sulfur colloid (Tc-99m), resulting in significant patient discomfort and pain. A previous randomized controlled trial showed that adding lidocaine to Tc-99m significantly reduced radioisotope injection-related pain. We tested whether 1 % lidocaine admixed with Tc-99m affects feasibility of SLN mapping.. Between January 2006 and April 2009, 140 patients with early breast cancer were randomly assigned (1:1:1:1) to receive standard topical 4 % lidocaine cream and intradermal Tc-99m (control) or to one of three other study groups: topical placebo cream and injection of Tc-99m containing sodium bicarbonate (NaHCO3), 1 % lidocaine, or both. All SLN data were collected prospectively.. Study groups were comparable for clinicopathological parameters. As previously reported, the addition of 1 % lidocaine to the radioisotope solution significantly improved patient comfort. Overall SLN identification rate in the trial was 93 %. Technical aspects of SLN biopsy were similar for all groups, including time from injection to operation, first SLN (SLN 1) gamma probe counts, ex vivo counts for SLN 1 and SLN 2, and axillary bed counts. SLN identification rates were comparable statistically: control (96 %), lidocaine (90 %), sodium bicarbonate (97 %), and sodium bicarbonate-lidocaine (90 %). The control group had a significantly higher SLN 2/SLN 1 ex vivo count ratio, and the number of SLNs detected was significantly reduced in the lidocaine versus no-lidocaine groups (p < 0.05).. Addition of 1 % lidocaine to standard radioisotope solution for SLN mapping in breast cancer is associated with fewer SLNs detected, but it does not appear to compromise SLN identification.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Breast Neoplasms; Double-Blind Method; Female; Humans; Lidocaine; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Pain; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Disparity between patient report and physician perception of pain from radiotracer injection for sentinel node biopsy is thought to center on the severity of the intervention, ethnic composition of population queried, and socioeconomic factors.. The objectives of this study were, first, to explore agreement between physicians' and their breast cancer patients' pain assessment during subareolar radionucleotide injection; and second, to evaluate potential ethnic differences in ratings.. A trial was conducted, from January 2006 to April 2009, where 140 breast cancer patients were randomly assigned to standard topical lidocaine-4% cream and 99mTc-sulfur colloid injection, or to one of three other groups: placebo cream and 99mTc-sulfur colloid injection containing NaHCO3, 1% lidocaine, or NaHCO3 + 1% lidocaine. Providers and patients completed numeric pain scales (0-10) immediately after injection.. Patients and providers rated pain similarly over the entire cohort (median, 3 vs 2, P = 0.15). Patients rated pain statistically significantly higher than physicians in the standard (6 vs 5, P = 0.045) and placebo + NaHCO3 (5 vs 4, P = 0.032) groups. No significant difference in scores existed between all African Americans and their physicians (3 vs 4, P = 0.27).. Patient-physician pain assessment congruence over the less painful injections and their statistically similar scores with the more painful methods suggests the importance of utilizing the least painful method possible. Providers tended to underestimate patients with the highest pain ratings-those in the greatest analgesic need. Lack of statistical difference between African American and physician scores may reflect the equal-access-to-care over the entire patient cohort, supporting the conclusion that socioeconomic factors may lie at the heart of previously reported discrepancies.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Cohort Studies; Female; Humans; Injections; Lidocaine; Lymph Nodes; Middle Aged; Pain; Pain Measurement; Patients; Physicians; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Technetium Tc 99m Sulfur Colloid

Sentinel-lymph-node (SLN) mapping and biopsy maintains staging accuracy in early breast cancer and identifies patients for selective lymphadenectomy. SLN mapping requires injection of technetium-99m-sulfur colloid-an effective but sometimes painful method, for which better pain-management strategies are needed. In this randomised, double-blind trial, we compared degree of pain between standard radiocolloid injection and pH-adjusted and lidocaine-supplemented formulations for patients undergoing SLN mapping for breast cancer.. Between Jan 13, 2006, and April 30, 2009, 140 patients with early breast cancer were randomly assigned in a 1:1:1:1 fashion to receive the standard topical 4% lidocaine cream and injection of [(99m)Tc]Tc-sulfur colloid (n=35), or to one of three other study groups: topical placebo cream and injection of Tc-sulfur colloid containing either sodium bicarbonate (n=35), 1% lidocaine (n=35), or sodium bicarbonate and 1% lidocaine (n=35). The randomisation sequence was computer generated, and all patients and investigators were masked to treatment allocation. The primary endpoint was patient-reported breast pain immediately after radioisotope injection, using the Wong-Baker FACES pain rating scale and McGill pain questionnaire, analysed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT00940199.. 19 of the 140 patients enrolled were excluded from analysis: nine declined study participation or sought care elsewhere, nine did not undergo SLN mapping because of disease extent or a technical problem, and one had unreliable data. There were no adverse events. Mean pain scores on the Wong-Baker scale (0-10) were: 6.0 (SD 2.6) for those who received standard of practice, 4.7 (3.0) for those who received radiocolloid plus bicarbonate, 1.6 (1.4) for those who received radiocolloid plus 1% lidocaine, and 1.6 (1.3) for those who received radiocolloid plus bicarbonate and 1% lidocaine (p<0.0001). Mean pain rating, according to the McGill questionnaire (0-78), was 17.5 (SD 11.8) for the standard-of-care group, 15.4 (14.4) for the sodium bicarbonate group, 4.6 (4.5) for the 1% lidocaine group, and 3.4 (5.1) for the sodium bicarbonate plus 1% lidocaine group (p<0.0001). SLN identification rates for each group were: 96% for the standard of care, 97% for sodium bicarbonate, 90% for 1% lidocaine, and 90% for sodium bicarbonate plus 1% lidocaine group (p=0.56).. For centres that use radiocolloid injections for SLN mapping in patients with early breast cancer, the addition of 1% lidocaine to the radioisotope solution can improve patient comfort, without compromising SLN identification.. US Military Cancer Institute, the Clinical Breast Care Project, and the Army Regional Anesthesia and Pain Management Initiative.

Topics: Adolescent; Adult; Anesthetics, Local; Breast Neoplasms; Double-Blind Method; Drug Combinations; Female; Humans; Injections, Intradermal; Lidocaine; Middle Aged; Pain; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Breast lymphoscintigraphy with

Topics: Aged; Anesthetics, Local; Attitude of Health Personnel; Breast Neoplasms; Female; Humans; Injections; Lidocaine; Lymphoscintigraphy; Middle Aged; Pain; Patient Satisfaction; Preoperative Care; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Lymphoscintigraphy plays a vital role in sentinel lymph node (SLN) identification in oncologic breast surgery. The effectiveness of SLN localization and the degree of patient pain were compared between filtered

Topics: Breast Neoplasms; Dextrans; Female; Humans; Lymphoscintigraphy; Mannans; Middle Aged; Pain; Retrospective Studies; Sentinel Lymph Node Biopsy; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid; Wounds and Injuries

Preoperative sentinel node localization (SNL) using a subareolar injection of radiotracer technetium-99m-sulfur colloid (Tc(99m)SC) is associated with significant pain. Lidocaine use during SNL is not widely adopted partly due to a concern that it can obscure sentinel node identification and reduce its diagnostic accuracy. We prospectively identified women with a biopsy-proven infiltrating breast cancer who were awaiting a SNL. The women completed the McGill pain questionnaire, Visual Analog Scale, and Wong-Baker FACES Pain Rating Scale prior to and following SNL. We identified a retrospective cohort of women with similar demographic and tumor characteristics who did not receive lidocaine before SNL. We compared sentinel lymph node identification rates in the two cohorts. We used Wilcoxon rank sum tests to compare continuous measures and Fisher's exact test for categorical measures. Between January 2011 to July 2012, 110 women consented, and 105 were eligible for and received lidocaine prior to Tc(99m)SC injection. The post-lidocaine identification rate of SNL was 95 % with Tc(99m)SC, and 100 % with the addition of intraoperative methylene blue dye/saline. Pain range prior to and following the SNL was unchanged (P = 0.703). We identified 187 women from 2005 to 2009 who did not receive lidocaine during preoperative SNL. There was no significant difference in the success rate of SNL, with or without lidocaine (P = 0.194). The administration of lidocaine during SNL prevents pain related to isotope injection while maintaining the success rate. We have changed our practice at our center to incorporate the use of lidocaine during all SNL.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Breast Neoplasms; Female; Humans; Lidocaine; Middle Aged; Pain; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Treatment Outcome

A triple-tracer nuclear medicine study that incorporates (99m)Tc-sulfur colloid, (111)In-labeled leukocytes, and (99m)Tc-methylene diphosphonate can be useful for the diagnosis of aseptic loosening in a patient after total-knee arthroplasty, as demonstrated in this case study. The triple-tracer technique takes less time and is more accurate than a bone scan alone.

Topics: Arthroplasty, Replacement, Knee; Female; Humans; Leukocytes; Middle Aged; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Anesthetics, Local; Breast Neoplasms; Drug Combinations; Female; Humans; Injections, Intradermal; Lidocaine; Pain; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

A series of plain radiographs, bone scans, bone marrow scans, and MRIs is reported in a patient with Gaucher disease type I, in whom two episodes of acute bone crisis developed during a 6-year period of follow-up. Acute bone crisis and global indolent bone marrow displacement could both be assessed by bone marrow scintigraphy, whereas MRI could better clarify the corti-comedullary alteration after bone infarction. Thus, MRI and bone marrow scintigraphy could be used as complementary imaging methods in the management of patients with Gaucher disease.

Topics: Acute Disease; Adult; Biopsy; Bone and Bones; Bone Diseases; Bone Marrow; Diagnostic Imaging; Follow-Up Studies; Gaucher Disease; Humans; Infarction; Magnetic Resonance Imaging; Male; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Bone and Bones; Child; Female; Humans; Naproxen; Osteosclerosis; Pain; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The diagnosis of esophageal disease can be made by history alone in 80 percent of patients. Primary symptoms include dysphagia, odynophagia, heartburn and central chest pain. Although these symptoms may overlap, one esophageal symptom often predominates. This observation and an understanding of the available diagnostic tests enable the clinician to develop an algorithmic approach to the diagnosis of esophageal diseases.

Topics: Barium Sulfate; Deglutition Disorders; Endoscopy; Esophageal Diseases; Esophagus; Fiber Optic Technology; Heartburn; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Manometry; Medical History Taking; Pain; Peristalsis; Technetium Tc 99m Sulfur Colloid; Thorax

Arthroscintigraphy was performed in 19 patients with a painful total hip prosthesis by injecting both Tc-99m sulfur colloid and iodinated radiographic contrast material intra-articularly. Scintigraphic and radiographic results correlated exactly in 15 patients, with one false-negative scintigram, one false-positive scintigram, and one false-negative arthrogram. One patient was evaluated by scintigraphy alone. Although arthroscintigraphy is potentially more sensitive than conventional arthrography in the detection of femoral component loosening, acetabular component loosening cannot be evaluated by scintigraphy alone. A combination of scintigraphy and conventional arthrography appears to be the most accurate imaging method in the evaluation of hip prosthesis loosening.

Topics: Arthrography; Hip Joint; Hip Prosthesis; Humans; Pain; Prosthesis Failure; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The diagnosis of hepatic rupture in patients with pregnancy-induced hypertension (preeclampsia and eclampsia) is rarely made preoperatively. Diagnostic imaging can be utilized in some patients to confirm the preoperative diagnosis. Since hematoma formation precedes hepatic rupture, then, when diagnostic modalities such as sonography and computed tomography identify patients with hematomas, these patients are at risk of rupture, and should be hospitalized until the hematomas resolve.

Topics: Abdomen; Adolescent; Adult; Female; Hematoma; Humans; Liver Diseases; Pain; Pre-Eclampsia; Pregnancy; Rupture, Spontaneous; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Based on strict predefined histologic criteria, we identified 23 patients with hepatic adenoma and 41 patients with focal nodular hyperplasia seen at this institution between 1961 and 1980. Patients with hepatic adenoma were young and 91% were female. When a reliable history was available, 89% had used oral contraceptives; 53% presented acutely or with pain. Eleven of 11 radionuclide scans were abnormal; 15 of 15 angiograms showed a hypervascular mass with 7 of 15 showing areas of hypovascularity. Eighteen resections were performed with one operative death. Two tumors contained areas of unequivocal hepatocellular carcinoma. Fifteen of 18 patients followed for 82 +/- 11 mo were living and well and had discontinued oral contraceptives. Focal nodular hyperplasia patients were older, 88% were female, and 58% had used oral contraceptives. Their lesions were discovered accidentally. Seven of 12 radionuclide scans demonstrated voids, while 13 of 13 angiograms showed hypervascular lesions with no areas of hypovascularity. Seventeen tumors were resected. Twenty-three of 24 patients followed for 45 +/- 7 mo were living and well. One died of nonhepatic causes. Based on the findings of this review, we believe that if the clinical suspicion of hepatic adenoma or focal nodular hyperplasia is strong, elective laparotomy for diagnosis is usually the best approach. Hepatic adenoma should be resected if technically feasible. Intraoperative wedge biopsy is appropriate for focal nodular hyperplasia.

Topics: Abdomen; Adult; Biopsy; Carcinoma, Hepatocellular; Contraceptives, Oral; Diagnostic Techniques, Surgical; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Male; Middle Aged; Pain; Palpation; Prognosis; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Angiography; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biopsy; Congresses as Topic; Female; Hamartoma; Humans; Middle Aged; Pain; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Abdomen; Aged; Animals; Barium Sulfate; Enema; Gastrointestinal Hemorrhage; Humans; Intestinal Neoplasms; Leiomyoma; Leiomyosarcoma; Male; Middle Aged; Pain; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid