The Use of Periareolar Topical Lidocaine Jelly After Needle Localization May Reduce Pain of Subsequent Lymphoscintigraphy

Purpose Technetium Tc-99m sulfur colloid (99mTc-SC) breast lymphoscintigraphy is commonly performed to identify the sentinel lymph node (SLN) in patients diagnosed with breast carcinoma undergoing lumpectomy. The purpose of this report is to describe how the use of 2% topical lidocaine jelly immediately after the completion of needle localization and prior to scintigraphy may substantially reduce pain associated with the injection of 99mTc-SC. Materials and methods This was a quality improvement project. Patients were asked to score the severity of pain associated with the periareolar 99mTc-SC injections for sentinel node lymphoscintigraphy. In order to decrease the discomfort, topical lidocaine was applied to the periareolar skin after the completion of the needle localization, but prior to transferring the patient from the mammography room to the nuclear medicine department for the 99mTc-SC injections. At the time of 99mTc-SC injection, patients were asked to score the pain of injection from 0 (none) to 10 (worst). Results The average pain score of the women who did not receive topical lidocaine jelly was 8 (range: 5-9). In the 10 women who received topical lidocaine jelly after needle localization, the average pain score was 2.5 (range: 1-5). Interestingly, the pain score for women who discussed the possible use of lidocaine jelly with the radiologists but still did not receive topical lidocaine jelly was also low at 6.5. For patients who received the lidocaine jelly only five minutes prior to injection, the average pain score was 6. Conclusion The application of lidocaine jelly after the conclusion of needle localization, with a 15-40-minute delay prior to periareolar injections with 99mTc-SC for sentinel node lymphoscintigraphy, appears to substantially reduce the pain associated with the injection of 99mTc-SC.