Table 2.

Comparison of different techniques of axillary lymph node localization with cost analysis, benefits and pitfalls.

Procedure	Cost (US$)	Advantages	Disadvantages
Carbon suspension/Charcoal tattoo	$100 per 5 mL vial	100% identification in node Seen up to 6–8 months after injection No side effects	Color misidentification Possibility of some ink migration to non-tattooed node or surrounding tissue One report of foreign body granulomas
Wire Localization	$25–30 per wire	Cost effective	Same day as surgery Pt discomfort, pain, hematoma, adjacent tissue injury High chance of migration due to arm movement, muscle contraction
Ultrasound visible clip	$60	Small in size 3 mm Sonographically visible up to 12–15 months Newer ones UltraCor, O-Twist not water absorbing	Will need intraop ultrasound to detect the clip Needs instrument confidence by the surgeon Hygroscopic, absorbs water and subject to migration Decreased visibility over time
Magnetic seed localization	$500 per seed $55,000 for probe and Console	Can be placed up to 30 days prior to surgery	Depth limitation 3.5 cm Cost Calibration required and susceptible to other magnetic fields If done prior to MRI breast, artifact in the axilla
I 125 radioactive seed localization	$17–60 per seed $15,000 for probe $30,000 for Console	Small size 4 × 0.8 mm Long half-life (60 days) Detectable up to 4 months post NAC by Gamma probe	Strict Nuclear Regulatory Commission protocol →Complete chain important from insertion to removal to retrieval of all seeds Migration chances more intraop than preop
SAVI SCOUT	$400 for Single use reflector $40,000 for probe	Up to 6–8 cm depth detection Operating room efficiency Long term placement up to 30 days before surgery	One report of migration due to hematoma