Scintigraphic Visualization of an Epigastric Sentinel Node in Recurrent Breast Cancer After Lumpectomy and Postoperative Radiation Therapy

Abstract

Sentinel node imaging and biopsy have become standard procedures for staging early breast cancer. Positive sentinel lymph node (SLN) biopsy necessitates the need for axillary lymph node dissection (ALND). Failure to visualize a sentinel lymph node in recurrent breast cancer after treatment by surgery, chemotherapy, and high-dose postoperative radiation therapy is almost the case in every patient. The reason for failure to visualize the sentinel node is the fibrosis that follows high-dose radiotherapy and blocks the lymphatics preventing spread of the tumor cells to the lymph nodes. Alternative pathways for the drainage of lymph from the breast are developed in these patients. We have previously reported on the alternative pathways of lymphatics to the contralateral axilla, supraclavicular area, and also reported on the development of intramammary lymph nodes. In this report, we are presenting another alternative pathway of lymphatics to the region of the epigastrium below the lower end of the sternum.

Intensity modulated radiotherapy and targeted therapy for late nonregional para-aortic lymph node metastasis from HER2 positive breast carcinoma

“…The external axillary drainage can also be found in 20-27% of BC cases, which includes the ipsilateral internal mammary chain (17%), intramammary (3%), interpectoral (2%), and supraclavicular (2%) nodes [5]. There have been accumulating knowledges that the lymphatic pathways are relatively easy to be altered after axillary lymph node (LN) dissection and/or radiation into the contralateral axilla [6,7], paravertebral [8], or epigastric nodes [9].…”

Detection of False Negative Sentinel Lymph Node in Cutaneous Oncology: A General Reappraisal

“…In both studies, it is highlighted that, in large lesions, after an incisional biopsy is performed, the wide excision should be always combined with SLNB [3,5]. Indeed, a reason for failure to visualize the SLN to excise and the risk to have a false negative SLNB is related to the fibrosis that follows the surgery of large lesions, since the fibrosis blocks the lymphatics, preventing and/or altering the spread of the tumor cells to the regional LNs [8].…”

Role of Re-Operative Sentinel Lymph Node Biopsy in Locally Recurrent Breast Cancer

“…Similarly, the establishment of communication between superficial lymphatics of the breast with deep lymphatics would facilitate alternative routes of lymphatic drainage that would bypass sentinel node identification. Such nodal groups may include the para‐aortic or internal thoracic groups of lymph nodes (8–10).…”