Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients

Abstract

Background: Preoperative lymphoscintigraphy is without doubt a valid method for the detection of the sentinel lymph node (SLN). There has been considerable debate regarding the optimal site for the introduction of the tracer; various sites include peritumoral (PT), periareolar (PA), subdermal, and intradermal injection. Purpose: To evaluate retrospectively the lymphoscintigraphic identification rate of peritumoral (PT) injection versus subdermal periareolar (PA) injection in the detection of SLNs in breast cancer. Material and Methods: Between October 2002 and December 2011, a cohort of 906 consecutive patients with biopsy proven breast cancer underwent 914 SLN biopsy procedures. A total of 339 procedures (Group A) were performed using a PT deep injection of radiotracer while 575 procedures (Group B) adopted a subdermal PA injection of radiotracer towards the upper outer quadrant, regardless of the site of the carcinoma. All the patients underwent synchronous excision of the breast cancer and SLN biopsy. Results: SLNs were identified in the lymphoscintigram in 308/339 cases (90.85%) of Group A (PT injection) and in 537/ 575 cases (93.39%) of Group B (PA injection). Furthermore, in 2/339 patients (0.58%) of Group A, internal mammary lymph nodes were found at lymphoscintigraphy, whereas no internal mammary sentinel nodes were found in the Group B patients. The intraoperative identification rate of axillary SLNs was 99.41% (337 of 339) in the Group A patients and 99.65% (573 of 575) in the Group B patients. There was no significant difference in the two groups between the incidence of the number of SLNs detected and the incidence of identification of positive SLNs. Conclusion: PT versus PA injection of radiotracer showed comparable success rates for axillary SLN identification, and can be considered a rapid and reliable method.

Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: the SentiMAG Multicentre Trial imaging subprotocol

“…There remains considerable debate about the different drainage patterns. Large differences between the drainage patterns from the different sites were recently reported in a small study, 32 while Caruso et al 33 concluded that the same SLNs were reached from different injection sites. In our study, the SLNs identified during surgery were both magnetic and hot in all but one patient, indicating similar drainage patterns, and thus supporting the conclusion drawn by Caruso.…”

Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer

“…These 18 studies underwent full‐text review and one further study was excluded from the systematic review on the basis of the absence of a preoperative diagnosis of invasive or in situ malignancy. Of the 17 studies remaining, another four were excluded from the meta‐analysis because there was no comparison of superficial versus deep injections of radiotracer with or without blue dye. Thus a total of 13 studies met the inclusion criteria for meta‐analysis ( Fig .…”

“…These six patients all had successful SLNB with 100 per cent SLN identification. Pelosi et al 34 26 Mateos et al 30 Maza et al 31 Mudun et al 32 Noushi et al 16 Rodier et al 35 Roumen et al 17 Shimazu et al 36 Uren et al 13 Total Heterogeneity: τ 2 = 0·74; χ 2 = 37·64, 8 d.f., P < 0·001; I 2 = 79% Test for overall effect: Z = 1·31, P = 0·19 24 Fowler et al 15 3 of 339 1 of 15…”

“…SLN, sentinel lymph node; LSG, lymphoscintigraphy; SA, subareolar; PT, peritumoral; H, hot (identified using radioisotope); B, blue (identified using blue dye). three 24,26,36 compared deep and superficial injections of radioactive tracer, but with blue dye also present ( Table 4), and four studies 27,28,33,34 compared different superficial injections of radioactive tracer and blue dye ( Table 5).…”

Anatomical classification of breast sentinel lymph nodes using computed tomography–lymphography

“…Several other reports have stated that SLN identification is not affected by the injection site regardless of whether the injection is intranipple or peritumoral (Kern 2001 ; Caruso et al. 2014 ; Rosenow et al. 2012 ).…”