Pattern of lymphatic drainage to the sentinel lymph node in breast cancer patients.
ABSTRACT 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.
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.
"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.
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.
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ABSTRACT: Objective To determine whether there are differences in the technical efficacy in detecting and biopsying the sentinel node after intratumoral or peritumoral administration of the radiotracer in patients with nonpalpable early-stage breast cancer. Material and methods This prospective, randomized study included 80 patients with nonpalpable breast cancer without axillary adenopathies who were scheduled for primary surgical treatment. Patients were randomized to one of two groups: the INTRA group (intratumoral radiotracer administration, n = 35) or the PERI group (peritumoral radiotracer administration, n = 45). Patients with suspicious axillary lymph nodes at clinical or ultrasonographic examination that had positive results after fine-needle aspiration cytology were excluded. Results The rates of sentinel node detection were 97.1% (34/35) for intratumoral injection and 84.4% (38/45) for peritumoral injection. Radiotracer migration failure occurred in 8 cases (one in the INTRA group and 7 in the PERI group). The sentinel node was detected in an extra-axillary location in 21.9% of cases (11/59 in the INTRA group and 16/64 in the PERI group). Conclusions Our study found no statistically significant differences in the detection rates of axillary or extra-axillary sentinel lymph nodes between the two groups; however, we observed greater technical efficacy with intratumoral radiotracer administration.Radiología 07/2008; 50(4). DOI:10.1016/S0033-8338(08)71990-8
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ABSTRACT: Abstract Background: A few studies about lymphoscintigraphy in breast cancer patients have reported a correlation between decreased sentinel lymph node (LN) uptake and increased risk of axillary involvement with the hypothesis of blocked lymphatic passage of radiotracers by metastatic burden. This study is designed to investigate whether the visible internal mammary LN of lymphoscintigraphy (IM-LPS) is related to axillary LN metastasis, rather than identifying sentinel LN in the internal mammary area. Methods: We retrospectively reviewed medical records of 401 breast cancer patients who underwent sentinel lymphoscintigraphy using Tc-99m phytate and subsequent axillary LN dissection. The IM-LPS was divided into positive or negative groups, and axillary lymphoscintigraphy (A-LPS) was visually graded into four groups according to the method suggested by Lee et al. (1) To evaluate the relation of positive IM-LPS and A-LPS pattern with axillary LN metastasis, multivariate logistic regression analysis was done with covariates of Memorial Sloan-Kettering Cancer Center model. Results: Positive IM-LPS was found in 32 patients. On the univariate logistic regression analysis, positive IM-LPS (p=0.01) and A-LPS pattern (p<0.05) successfully predicted the axillary LN status. On the multivariate logistic regression model, positive IM-LPS (OR 2.6362; 95% CI 1.0382-6.6938; p=0.04) and group II A-LPS (OR 1.9773; 95% CI 1.1336-3.4491; p=0.01) remained statistically significant variables for the predictor of axillary LN metastasis. Conclusion: This study suggests that IM-LPS and A-LPS pattern might be useful to show the burden of axillary LN metastasis in breast cancer patients, as an indicator of altered lymphatic pathway.Lymphatic Research and Biology 08/2014; 12(4). DOI:10.1089/lrb.2013.0039 · 1.66 Impact Factor
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ABSTRACT: It is still unclear whether the deep and superficial lymphatics of the breast always drain into the same nodes and which route best simulates the spread of breast cancer. In the current study, we systematically searched the available literature to find the studies evaluated the sentinel node locations of deep and superficial injections in the same patients simultaneously or serially. We searched SCOPUS, and PUBMED for relevant studies. Patient basis concordance rate was defined as the ratio of patients with at least one identified axillary sentinel node by both deep and superficial injections to all patients with identified axillary sentinel nodes using either methods. Sentinel node basis concordance was defined as the ratio of the number of axillary sentinel nodes identified by both deep and superficial injections to the sum of all identified axillary sentinel nodes using either methods. Pooled sentinel node detection rates were 94 % [92.1-95.5], 91.2 % [87.1-94.1], and 97.2 % [96-98] for superficial, deep, and combined (superficial and deep) injections. Pooled patient basis and sentinel node basis concordance rates were 90 % [86.7-92.4] and 73 % [63.3-80.9]. Pooled false negative rates were 9.1 % [5.9-14], 8.6 % [3.7-18.8], and 6.5 % [3.4-11.9] for superficial, deep, and combined (superficial and deep) injections, respectively. Axillary lymphatic drainage concordance between superficial and deep sentinel node mapping material in breast cancer patients is fairly high and clinically acceptable. However, both injection techniques can complement each other and the combined superficial/deep injection technique seems to be more successful clinically and can decrease the overall false negative rate.Breast Cancer Research and Treatment 02/2014; DOI:10.1007/s10549-014-2866-1 · 4.20 Impact Factor