Different sites and modes of tracer injection for mapping the sentinel lymph node in patients with breast cancer

Citation
P. Bianchi et al., Different sites and modes of tracer injection for mapping the sentinel lymph node in patients with breast cancer, TUMORI, 86(4), 2000, pp. 307-308
Citations number
12
Categorie Soggetti
Onconogenesis & Cancer Research
Journal title
TUMORI
ISSN journal
03008916 → ACNP
Volume
86
Issue
4
Year of publication
2000
Pages
307 - 308
Database
ISI
SICI code
0300-8916(200007/08)86:4<307:DSAMOT>2.0.ZU;2-G
Abstract
Several studies have been published describing the techniques of identifica tion of the "sentinel lymph node" (SN), There are marked differences In the techniques used by different investigators. Although agreement exists abou t the tracer particle size and the volume of injection, it is unknown what is the best site where to inject the tracer or the vital dye. The aim of th e present study was to define the influence of different sites of injection on Imaging of the lymphatic ducts and their SNs, We performed a pilot stud y in 30 consecutive patients with breast cancer who underwent SN biopsy by means of radioguided surgery and vital blue dye mapping. The patients were divided Into six groups of five patients each; each patient was given a sub dermal (ID) or peritumoral (IP) injection of radiotracer (300 mu Ci in 150 mL of Tc-99m-HSA microcolloids; Albures, Amersham Sorin) above the tumor si te in order to localize the SN. After the identification of the SN, a secon d injection of radiotracer was performed, which was different in each patie nt subset. In some cases more than one lymph node appeared on the lymphosci ntigraphic scans after the second injection of radiotracer. When the peritumoral route was used it took longer to visualize the lymphat ic pathways. For the ID route, injection at the exact skin projection over the tumor is optimal. Internal mammary lymph nodes were identified by both IP (2) end ID (1) injection, irrespective of the quadrant in which the trac er was injected. Our findings support the hypothesis of a precise topographic correspondence between the primary tumor and its specific SN. The subdermal route is more accurate than the intraparenchymal route, as it allows faster identificati on of the lymphatic vessels and SN, We believe these observations should be taken into account for the proper selection of the injection site of eithe r vital dye or radiopharmaceuticals.