Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy

Noguchi, Masakuni; Inokuchi, Masashi; Zen, You

doi:10.1002/jso.21308

Cited by 55 publications

(38 citation statements)

References 34 publications

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“…However, the false-negative rate was twice higher (10%) if only blue nodes or only green nodes were considered (27). Thus, it might be appropriate to use 2 different injection sites; for example, peritumoral for the radiotracer and subareolar for blue dye (9,28). Peritumoral injection of the radiotracer can evidence extraaxillary drainage (9).…”

Section: Effect Of a Different Injection Site For Radiotracer And Blumentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the factors influencing the false-negative rate of SNB in breast cancer; (2) the risks associated with the use of the technique in specific situations such as large tumors, multiple ipsilateral tumors, or the setting of neoadjuvant chemotherapy; and (3) the meaning of internal mammary drainage on lymphoscintigraphy in terms of risk of occult internal mammary involvement.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through March 2012.Axillary node status is a major prognostic factor in early breast cancer. Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (,5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting patients for whom internal mammary radiation has a high benefit-to-risk ratio.Key Words: sentinel node biopsy; breast cancer; micrometastases; lymphoscintigraphy; internal mammary node; radiation therapy; neoadjuvant chemotherapy Because imaging techniques have limited sensitivity, the axilla must be explored surgically. Traditional staging requires levels I and II axillary lymph node dissection (ALND) with 10 or more removed nodes (3). Axillary involvement is found in 10%-30% of patients with T1 (#2 cm) tumors, depending on size. This rate reaches 45% for small T2 tumors (2.1-3 cm) and 55%-70% for larger tumors (2,4). However, routine ALND carries the risk of lymphedema, sensory disturbances, and chr...

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Section: Effect Of a Different Injection Site For Radiotracer And Blumentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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“…Although the fluorescent axillary reverse mapping nodes and/or lymphatics were not observed in 2 patients, they were early cases in the study (Noguchi et al, 2010b). Thus, the fluorescence imaging technique is useful for detecting lymphatic drainage from the upper extremity, and it also permits differentiation of fluorescent axillary reverse mapping nodes and/or lymphatics from blue and/or hot sentinel lymph nodes (Noguchi et al, 2009). …”

Section: Mapping By Fluorescent Imagingmentioning

confidence: 91%

“…Thereby, two potential routes of lymphatic connections from the breast parenchyma to the axilla have been suggested: (a) direct lymphatic connections from the breast parenchyma to the axilla and (b) drainage of parenchyma via the subareolar complex into the axillary lymph nodes (Fig. 2) (Noguchi, 2009). This knowledge is important with regard to the optimal injection site for identifying sentinel lymph node in breast cancer, because subareolar injection may not always identify the same sentinel lymph node as peritumoral injection (Noguchi et al, 2009).…”

Section: Lymph Nodes and Lymphatics From The Breast And The Upper Extmentioning

confidence: 99%

“…2) (Noguchi, 2009). This knowledge is important with regard to the optimal injection site for identifying sentinel lymph node in breast cancer, because subareolar injection may not always identify the same sentinel lymph node as peritumoral injection (Noguchi et al, 2009). On the other hand, superficial and deep lymphatics from the upper extremity always flow into the axillary lymph node (called the "sentry node") ( Fig.…”

Section: Lymph Nodes and Lymphatics From The Breast And The Upper Extmentioning

confidence: 99%

“…To use axillary reverse mapping, moreover, surgeons must use only isotope in the breast to use blue dye in the arm (Klimberg, 2008). This would not be acceptable for those surgeons who believe that the blue dye and radioisotope techniques are complementary for identifying sentinel lymph nodes (Albertini et al, 1996;Noguchi et al, 2000;Noguchi et al, 2009). …”

Section: Mapping By Blue Dye Injectionmentioning

confidence: 99%

See 2 more Smart Citations

Axillary Reverse Mapping in Breast Cancer

Noguchi¹,

Yokoi²,

Nakano³

et al. 2011

Radioisotopes - Applications in Bio-Medical Science

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Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer

Noguchi

Yokoi

Nakano

2010

Journal of Surgical Oncology

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Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy

Abstract: The success of SLN mapping is optimized not only by using dye and isotope in combination but also by using PT and SA injections in combination.

Cited by 55 publications

References 34 publications

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Axillary Reverse Mapping in Breast Cancer

Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer

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