***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Radiotracer and blue dye mapping of sentinel lymph nodes ( SLN ) have been advocated as accurate methods to stage the clinical ly negative axilla in breast cancer patients . The technical aspects of SLN biopsy are not fully characterized . In this study we compare the results of intraparenchymal ( IP ) and intradermal ( ID ) injection of Tc-99 m sulfur colloid , to establish an optimal method for SLN localization . Methods : 200 consecutive patients had SLN biopsy performed by a single surgeon . Of these , 100 ( Group I ) had IP injection and 100 ( Group II ) had ID injection of Tc-99 m sulfur colloid . All patients had IP injection of blue dye as well . Endpoints included ( 1 ) successful SLN localization by lymphoscintigraphy , ( 2 ) successful SLN localization at surgery , and ( 3 ) blue dye – isotope concordance ( uptake of dye and isotope by the same SLN ) . Results : Isotope SLN localization was successful in 78 % of Group I and 97 % of group II patients ( P < .001 ) . When isotope was combined with blue dye , SLN were found in 92 % of group I and 100 % of Group II ( P < .01 ) . In cases where both dye and isotope were found in the axilla , dye mapped the same SLN as radiotracer in 97 % of Group I and 95 % of Group II patients . Conclusions : The dermal and parenchymal lymphatics of the breast drain to the same SLN in most patients . Because ID injection is easier to perform and more effective , this technique may simplify and optimize SLN localization BACKGROUND AND OBJECTIVE We performed a pilot study on 30 consecutive patients undergoing sentinel node ( sN ) biopsy by radioguided surgery and vital blue dye mapping  to determine whether there is a single sN for each breast independent of tumor site or an sN specifically related to the site of the breast neoplasm . METHODS There were 6 groups of 5 patients ; each patient had a subdermal injection of radiotracer on the tumor site plus a second injection of radiotracer that was changed in every subset of patients to test whether modifying the site or the route of injection could have impaired the proper detection of the sN. RESULTS " False " sN were detected only in patients who had a second injection of radiotracer away from the tumor site ; this occurred in 2 of 5 patients ( 40 % ) in group I , in 3 of 5 patients ( 60 % ) in group II , in all patients in group III , and in 3 of 5 patients ( 60 % ) in group IV . The different route of injection ( peritumoral or subdermal ) always on the tumor site that was tested in groups V and VI did not impair the proper detection of the sN. CONCLUSIONS Our findings support the hypothesis of a precise topographic correspondence between the primary tumor and its specific sN more than the existence of a first sN in the axillary basin , which indiscriminately drains all quadrants of the breast , like " a neck of a bottle . " This should be considered for the proper selection of the injection site of either vital blue dye or radiopharmaceuticals Background Sentinel lymph node ( SLN ) mapping with radioisotope and blue dye is rapidly becoming the st and ard of care for breast cancer . The optimal location for injection of radioisotope and blue dye is still being investigated . The goal of this study was to determine whether blue dye injection into the subareolar ( SA ) location localized the same sentinel nodes as the peritumoral ( PT ) location for patients with breast cancer . Methods Three hundred thirty-two patients with biopsy-proven operable breast cancer or ductal carcinoma in situ at two institutions underwent SLN mapping . Eighty-three patients had PT injection of blue dye  ( group 1 ) , and 249 patients had SA injection of blue dye ( group 2 ) . All patients underwent PT injection of99mTc-labeled sulfur colloid . Results The two groups were similar in age , previous biopsy type , and tumor size , location , and histology . The mean number of SLNs identified was 2.4 ( range , 0–9 ) in group 1 and 2.5 ( range , 0–11 ) in group 2 . The SLN identification rate was 95 % for group 1 and 97 % for group 2 . The isotope success rate was 94 % for both groups . The blue dye success rate was 84 % for group 1 and 90 % for group 2 . The isotope/blue dye concordance rate was 87 % for group 1 and 90 % for group 2 . At a median follow-up of 28 months ( range , 14 to 40 ) , there were no axillary recurrences in any of the 332 patients . Conclusions These data suggest that delivery of mapping reagents in the SA and PT locations identifies similar lymph nodes . Because of simplicity and the similarity in node identification between SA and PT injection , further investigation of the SA site for delivery of SLN mapping reagents for breast cancer is warranted Background Preoperative parenchymal or peritumoral ( PT ) injection of 99mTc-labeled sulfur colloid ( TcSC ) is the st and ard method for sentinel lymph node ( SLN ) identification in patients with breast cancer . Limitations of this method include variable identification rates , slow transit times , and painful injections . We hypothesize that TcSC will travel to the SLN within minutes after injection into the subareolar ( SA ) lymphatics , thus making an intraoperative injection technique feasible . Methods One hundred twenty-two women with invasive breast cancer were enrolled onto this prospect i ve study . Immediately after the induction of general anesthesia , patients were injected with 1 to 2 mCi of filtered TcSC in the SA location . Then , 5 mL of 1 % isosulfan blue dye was injected into the PT location . The SLN or SLNs were identified as radioactive , blue , or both and removed for pathologic evaluation . Results The mean patient age was 56 years . The mean tumor size was 1.5 cm . In 86.1 % of patients , a transcutaneous axillary “ hot spot ” was identified by h and held gamma probe . The mean time from  TcSC injection to axillary incision was 17.6 minutes . At least one SLN was identified in 99.2 % of patients . The mean number of SLNs identified per patient was 1.83 . The mean count of radioactive SLNs was 2715 cps . In 97.2 % of patients , blue SLNs were also radioactive . Conclusions TcSC injected into the SA lymphatics rapidly drains to the SLN . The radioactive SLN is easily and quickly identified after an intraoperative SA TcSC injection . The simplicity of this method eliminates the inherent problems associated with st and ard PT injection First published in 1996 , the CONSORT guidelines were created to address inadequate reporting of clinical trials , especially individually r and omized , two-group , parallel trials . The original guidelines were developed by a team of statisticians , epidemiologists , and biomedical editors and were revised in 2001 and again in 2010 ( Moher , Schultz , & Altman , 2001 ; Schulz , Altman , & Moher , 2010 ) . The intent of the CONSORT checklist and flow diagram was to provide a template for authors to fully and accurately describe research methodology . Moher and colleagues ( 2001 ) asserted that whereas inadequate reporting hinders interpretation , it also “ borders on unethical practice when biased results receive false credibility ” ( p. 4 ) . The latest CONSORT statement , checklist , flow diagram , and explanation and elaboration document are available on the website ( http://www.consort-statement.org ) or from one of several publications such as Schulz and colleagues ( 2010 ) . The CONSORT guidelines can be useful whether or not the study was design ed as a r and omized controlled trial ( RCT ) . Although most applicable to an RCT , the author of a quantitative study who chooses only the relevant checklist elements will still benefit from prompts to include the appropriate information in the introduction , methods , results , and discussion sections . Fuzzy reporting and omission of critical information comprise the majority of review ers ’ comments and queries back to authors of manuscripts su bmi tted for peer review . For example , authors frequently omit adequate description of the “ setting s and locations where the data were collected ” and have a tendency to gloss over limitations that should include “ sources of potential bias , imprecision , and , if relevant , multiplicity of analyses ” ( Schulz et al. , 2010 , p. 2 ) . PRISMA : PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEW S AND AIMS Identification of  sentinel lymph nodes ( SLN )  may depend on the tissue plane of tracer injection . To explore this , we developed a dual-isotope technique to compare the lymphatic drainage basins accessed by intradermal and parenchymal injections . METHODS Fifteen breast cancer patients had simultaneous parenchymal and intradermal injections of (99m)Tc-labelled human immunoglobulin G ( HIG ) and (111)In-HIG , respectively , 2 - 4h before axillary lymph node clearance surgery . All 228 freshly dissected nodes were assayed by well counting and examined for metastatic disease by haematoxylin/eosin staining and immuno-histochemistry . RESULTS Total nodal uptake following intradermal injection was 10 times more than after parenchymal injection .  Tracer uptake within the first three draining nodes divided patients into three groups ; four ( group 1 ) had identical 1st , 2nd and 3rd echelon nodes , six ( group 2 ) had identical 1st and 2nd echelon nodes and five ( group 3 ) had different 1st echelon nodes . With respect to the first , second and third groups , there was close , moderate and poor correlation ( Pearson ) , respectively , between individual nodal counts accumulated from the two injection sites . Of eight patients with nodal disease , the SLN identified by intradermal and parenchymal injections contained disease in seven and four patients , respectively . CONCLUSIONS Comparison of nodal tracer distributions from the two injection planes allows a functional model to be developed with two possible routes of drainage from the parenchymal plane , one joining the tract from the areolar plexus and the other passing independently to the axilla which builds upon Sappey 's original anatomical model . This may explain the variable uptake , discordance and false negative SLN identification BACKGROUND Sentinel lymph node ( SLN ) biopsy is fast becoming the st and ard for testing lymph node involvement in many institutions . However , questions remain as to the best method of injection . The authors hypothesized that a subareolar injection of material would drain to the same lymph node as a peritumoral injection , regardless of the location of the tumor . METHODS To test this theory , 68 patients with 69 operable invasive breast carcinomas and clinical ly node-negative disease were enrolled in this single-institution Institutional Review Board-approved trial . Patients were injected with 1.0 mCi of technetium-99 sulfur colloid ( unfiltered ) in the subareolar area of the tumor-bearing breast . Each patient received an injection of 2 to 5 cc of isosulfan blue around the tumor . Radioactive SLNs were identified using a h and -held gamma detector probe . RESULTS The average age of patients entered into this trial was 55.2 + /- 13.4 years . The average size of the tumors was 1.48 + /- 1.0 cm . Thirty-two percent of the patients had undergone previous excisional breast biopsies . Of the 69 lesions , 62 ( 89.9 % ) had SLNs located with the blue dye and 65 ( 94.2 % ) with the technetium . In four patients , the SLN was not located with either method . All blue SLNs were also radioactive . All located SLNs were in the axilla . Of the 62 patients in which the SLNs were located with both methods , an average of 1.5 + /- 0.7 SLNs were found per patient , of which 23.2 % had metastatic disease . All four patients in which no SLN was located with either method had undergone prior excisional biopsies . CONCLUSIONS The results of this study suggest that subareolar injection of technetium is as accurate as peritumoral injection of blue dye . Central injection is easy and avoids the necessity for image-guided injection of nonpalpable breast lesions . Finally , subareolar injection of technetium avoids the problem of overlap of the radioactive zone of diffusion of the injection site with the radioactive sentinel lymph node , particularly in medial and upper outer quadrant lesions UNLABELLED AIM of this study was to determine whether the sentinel lymph nodes ( SLNs ) can be accurately identified in breast cancer patients with  intradermal injection of the radiotracer  above the primary tumour in comparison to peritumoural injection . METHODS In 45 women with breast cancer we performed lymphoscintigraphy on two separate days . We injected Tc-99 m nanocolloid on the first day peritumourally , and on a separate day intradermally . The results of both investigations using different injection sites were compared in order to determine the number and location of SLNs . RESULTS The SLN identification rate using peritumoural injection was 71 % ( 32 of 45 patients ) and 96 % ( 43 out of 45 patients ) using intradermal injection . In 62 % ( 28 of 45 patients ) the number 
    Output:
    
Axillary lymphatic drainage concordance between superficial and deep sentinel node mapping material in breast cancer patients is fairly high and clinical ly acceptable .
However , both injection techniques can complement each other and the combined superficial/deep injection technique seems to be more successful clinical ly and can decrease the overall false negative rate