Interest of periareolar injection for colorimetric detection of sentinel node in breast cancer

Most teams working on sentinel node biopsy in the treatment of breast cance r inject either radioactive colloid or vital blue dye around the primary tu mour. Many anatomical studies and lymphoscintigraphical studies some very o ld, have shown that the lymphatic drainage of the breast is collected first in the periareolar plexus of Sappey, then routed to the axilla in 95% of c ase, via one or two primary collectors. In a series of 94 breast cancers me asuring less than 3 cm, with any palpable axillary lymph node, 2 ml of pate nt blue was injected intradermally around the areola, at the two meridians around the tumor. The sentinel node was identified in 89 cases (94,7%), reg ardless of the location of the primary tumor. All the sentinel nodes were l ocated in the lower axilla. An average of 1.6 nodes were found per patient. In 41 cases, axillary lymph node dissection was performed either immediate ly (5 technical failures, 9 positive frozen section) or delayed only if the sentinel node was positive, either on standard H&E staining or on immunohi stochemistry (27 cases). Thus, axillary lymph node dissection was not perfo rmed in 48 patients (55%). In positive node patient, the sentinel node was the only positive lymphnode in 20 patients (55%). For 5 positive node patie nts, axillary lymph node dissection was not performed: poor vital status (2 micro-metastatic nodes) or by decision of patient (3 IHC positive nodes). With this periareolar injection procedure, the rate of detection is highly satisfactory and is comparable to that usually published with peritumoral i njection. This procedure seems appropriate in all cases, regardless of the topography, the size or the multifocality of breast cancer.