Sentinel Lymph Node Biopsy in Patients with Breast Cancer: Comparison of Peritumoral and Periareolar Injection

Abstract

Introduction: Intradermal periareolar injection technique for sentinel lymph node biopsy (SLNB) may offer an advantage by including multifocal breast cancer as an additional indication. In May 2008 we changed our standard procedure from peritumoral (PT) to periareolar (PA) injection. We compared the results for corresponding periods before and after the change in procedure. Material and Method: A total of 117 patients (pts.) were investigated the year after we changed our technique; a total of 152?pts were investigated in the reference period 2007. We investigated the identification rates for sentinel lymph nodes (SLN) identified scintigraphically and surgically as well as the rates of metastatic involvement (LN). Results: After PT injection, scintigraphic detection of SLN failed in 5/152?pts., and in a further 10?pts. SLN was not found at surgery. In 7 of 15?pts. in whom SLN was not detected, histology demonstrated nodal involvement. Metastases were found in the SLN of 28 of 137?pts. with successful detection of SLN; no other lymph nodes were affected in 21 of these pts. (75.0?% of pts. with positive SLN detection). With PA injection at least one SLN could always be detected using scintigraphy; only 2/117 SLN could not be found intraoperatively. Metastasis was found in SLN in 34/115?pts.; in 19/34?pts., metastatic involvement was limited to the SLN with no other lymph nodes involved (55.9?% of pts. with positive detection of SLN). Discussion: The detection rate for SLN was significantly higher using PA injection (98.3?% vs. 90.1?%). As axillary dissection was not done in SLN-negative patients, rates of false-negative detection cannot be determined. PA injection not only results in better detection rates, it also offers the advantage that the technique can be performed correctly regardless of tumour localisation.

Isolated Loco-Regional Recurrence of Breast Cancer - Established and Innovative Therapy Concepts

“…Regular follow-up examinations to confirm that the patient is tumour-free with no local or axillary recurrence are important. As many patients are regularly followed up, the therapy of loco-regional recurrence is predominantly curative (50-70 %) and only palliative in around 30% of patients [9][10][11][12][13][14][15]. l " Table 2 lists the risk factors for developing loco-regional recurrence [8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Efficacy of Periareolar Versus Peritumoral Injection of TC99-Labelled Sulphur Colloid and Methylene Blue Dye for Detection of Sentinel Lymph Node in Patients with Early Breast Cancer: a Comparative Study

“…In a study by Rosenow et al [11], rate of intraoperative identification of SLN via periareolar route was 98.3% and via peritumoral route was 93.2%; the difference was not significant (p value = 0.07).…”

“…In a study by Rosenow et al [11], rate of having pathological positive sentinel nodes on final histopathology done via periareolar route was 29.6% and via peritumoral route was 20.4%; the difference was not significant (p value = 0.11). Chi-square = 0.509 with 1 degree of freedom; p = 0.475…”

Linfografía mediante imagen por resonancia magnética en modelo animal canino

“…La inyección subcutánea del agente de contraste en el área periareolar de la glándula mamaria es una de las técnicas más adecuadas para identificar el drenaje en estadios tempranos de tumores mamarios, porque tanto el drenaje linfático de la glándula mamaria como el de la parte superficial de la piel de la zona y el tumor comparten las mismas vías de drenaje hacia el linfonodo axilar [20], [21]- [24]; esto se demuestra al volverse azul y radioactivo el linfonodo centinela, cuando se inyecta el coloide dentro del tumor y el colorante por vía subdérmica [25], [24]. Además, la inyección subdérmica presenta otras ventajas, como el hecho de ser más exacta en la detección de tumores no palpables o múltiples tumores.…”

“…Aunque se desconoce el mecanismo exacto de absorción y transporte en el sistema linfático del gadopentetato de dimeglumina, este agente probablemente drena desde el espacio intersticial a las vías linfáticas a través de microvasos linfáticos de paredes delgadas y fenestradas, gracias a la combinación de los efectos de la presión, la os-mosis y el volumen, similares a otras sustancias hidrosolubles y de bajo peso molecular [12]- [14,] [24], [26]- [31]. La visualización de cada linfonodo puede mostrar un bajo tránsito y el secuestro de este agente de contraste en las sinusoides de cada linfonodo [13]; La visualización desde el lugar de inyección del agente de contraste hasta el primer relevo ganglionar es de gran importancia en el cartografiado del conducto linfático y del linfonodo al que drena [32]- [34].…”