Lymphoscintigraphy, along with triangulated patient body marking, can serve as a guide for surgeons during sentinel lymph node harvesting. Unique drainage patterns have been noted, especially with areolar or intradermal based injections, which are becoming increasingly popular. The images lymphoscintigraphy provide have been invaluable in delineating these patterns. The authors present a case that simultaneously illustrates two separate points in the same patient, a reverse echelon node and a lymphatic ectasia. To our knowledge, this combination has never been described in the same patient. Perilesional and areolar-cutaneous junction injections were performed sequentially and generated these patterns that could potentially have resulted in added morbidity and a false-negative sentinel node if not realised before surgery. Lymphoscintigraphy added valuable information in the management of this patient, which can occasionally present with complex patterns of activity during sentinel node harvesting.

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The authors report a case of recurrent breast carcinoma in the right chest in a patient who earlier had a right breast mastectomy. Injection of Tc-99m sulfur colloid into the lesion site in the right midchest revealed drainage to a very faint node in the contralateral axilla on the left, an unexpected site, and none to the ipsilateral axilla, the expected site. Disease was found in the left axilla in the sentinel nodes. Lymphoscintigraphy added valuable information in the management of this patient.

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A 44-year-old woman with bilateral breast implants and biopsy-proved infiltrating, moderately differentiated duct carcinoma was referred for lymphoscintigraphy for sentinel lymph node biopsy. Injection of Tc-99m sulfur colloid was performed perilesionally, taking great care not to inject into the breast implant, which was to remain in the chest. A layer of activity eventually spread along the capsule enclosing the breast implant from the perilesional injection. Subsequently, an areolar-cutaneous junction injection was performed to further augment activity in the sentinel node. The original sentinel node was enhanced along with what represents a reverse echelon node.