Layering of Activity Around a Breast Implant Capsule During Lymphoscintigraphy

Abstract

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.

Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer

“…Because these complex patterns arise immediately after injection and the changes continue over time, the information the camera provides in the form of dynamic images, multi-angle views and delayed views, is valuable in resolving the true nature of the patterns, a process in which the probe is severely disadvantaged. In fact, intraoperative injections could actually prolong surgery and increase dissection/morbidity in some patients, as a result of the complex post injection dynamic patterns described above [ 38 , 43 , 45 , 55 , 68 , 69 , 72 , 74 , 96 , 106 , 107 , 110 - 112 ]. If internal mammary sentinel nodes are deemed important to visualize, then the use of concurrent perilesional injections as part of a hybrid injection protocol of areolar and perilesional injections is necessary, as areolar injections do not delineate internal mammary nodes to any extent [ 38 , 72 , 113 - 115 ].…”

“…Most importantly a more targeted surgical approach will result in a reduction in patient morbidity. We observed unique patterns of drainage that can have an impact on the false negative rate and morbidity [ 38 , 43 , 50 , 55 , 69 - 72 , 74 , 77 , 96 , 107 , 113 , 115 ]. Based on the vast experience in imaging of multiple authors as well as ourselves [ 11 , 38 , 40 , 42 - 45 , 47 , 48 , 50 , 55 , 57 , 69 - 72 , 74 , 77 , 96 , 107 , 111 - 115 , 126 - 129 ], the general techniques described here form the basis of a logical algorithm for patient management.…”