A pilot study of dual-isotope lymphoscintigraphy for breast sentinel node biopsy comparing intradermal and intraparenchymal injection

Abstract

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Imaging Lymphatic System in Breast Cancer Patients with Magnetic Resonance Lymphangiography

“…Periareolar intradermal contrast injections can cause minor tissue injury, namely superficial erythema and blistering at the injection site. We found that tissue injury at the injection sites was temporary and reactions fell within the expectations of clinical experience [28] Moreover, no irreversible or unexpected adverse events have been reported in prior contrast-enhanced MRL studies, which is confirmed by our observations [10,12,13,29,30]. …”

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

“…However, the meta‐analysis clearly demonstrated that significantly fewer extra‐axillary SLNs were identified on superficial injection of radioactive tracer compared with deep injection. This contradicts the accepted notion that the lymphatic drainage of the breast parenchyma and areola converge at the first‐ or second‐echelon nodes in the axilla. It suggests that the drainage of the breast is more variable than previously thought, with the parenchymal lymphatics having interconnections with perforating lymphatic vessels, which pierce the intercostal fascia and terminate within the IMNs.…”

“…The discordance between SLNs identified using superficial and deep injections of radioactive tracer was examined in six studies ( Tables and ). The discordance ranged between 4 per cent and 73 per cent for axillary mapping, and 0 per cent and 61 per cent for internal mammary node (IMN) mapping. Noushi et al .…”

“…However, the use of sequential administration of the same radioactive tracer in deep and superficial locations in these studies means that intraoperative determination of the source of SLN radioactive tracer uptake by SLNB is difficult. Fowler and colleagues addressed this issue by using two different radioactive tracers. They found metastatic disease in eight patients; the ‘hottest’ node contained metastatic disease in seven of eight patients for the ID–PA injection, but only four of eight for the PT injection.…”

“…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…”