Technetium-99m-labeled albumin Nanocolloid (from January 2016 to February 2019: Nanocoll, GE Healthcare, Eindhoven, The Netherlands; from March 2019 to April 2021: Nanoscan, Radiopharmacy, Budaörs, Hungary) was administrated via an intratumoral injection, by a resident or an experienced nuclear medicine physician, either by palpation in palpable tumors or ultrasound-guided in nonpalpable tumors. An injected dose of approximately 120-MBq technetium-99m-labeled albumin Nanocolloid in a volume of 0.25 ml was administered in the afternoon of the day prior to surgery. Planar lymphoscintigraphy was performed at 15-min pi and 2-h pi. If planar lymphoscintigraphy showed SLN nonvisualization at 2-h pi, single photon emission computed tomography/computed tomography (SPECT/CT) imaging or a second periareolar injection of 120 MBq, followed by repeated planar lymphoscintigraphy, and sometimes additional SPECT/CT imaging, 2-h later (i.e. 4-h pi), were performed. As nonvisualization at 2-h pi is an important decision moment for further diagnostic intervention, we focused our analysis on this time point. Focal accumulations in at least one axillar lymph node were defined as SLN. SLN nonvisualization was clinically classified as nonvisualization when no SLN was visualized on routine clinical lymphoscintigraphy, as earlier described [8 (link)].
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