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

P. Bianchi, G. Villa, F. Buffoni, G. Agnese, M. Gipponi, R. Costa, C. Maragliano, G. Canavese, G. Mariani

Research output: Contribution to journalArticle

Abstract

Several studies have been published describing the techniques of identification of the 'sentinel lymph node' (SN). There are marked differences in the techniques used by different investigators. Although agreement exists about 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 the 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 study 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 subdermal (ID) or peritumoral (IP) injection of radiotracer (300 μCi in 150 mL of 99mTc-HSA microcolloids; Albures, Amersham Sorin) above the tumor site in order to localize the SN. After the identification of the SN, a second injection of radiotracer was performed, which was different in each patient subset. In some cases more than one lymph node appeared on the lymphoscintigraphic scans after the second injection of radiotracer. When the peritumoral route was used it took longer to visualize the lymphatic 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) and ID (1) injection, irrespective of the quadrant in which the tracer 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 identification of the lymphatic vessels and SN. We believe these observations should be taken into account for the proper selection of the injection site of either vital dye or radiopharmaceuticals.

Original languageEnglish
Pages (from-to)307-308
Number of pages2
JournalTumori
Volume86
Issue number4
Publication statusPublished - 2000

Keywords

  • Breast cancer
  • Lymphatic mapping
  • Sentinel node

ASJC Scopus subject areas

  • Cancer Research

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    Bianchi, P., Villa, G., Buffoni, F., Agnese, G., Gipponi, M., Costa, R., Maragliano, C., Canavese, G., & Mariani, G. (2000). Different sites and modes of tracer injection for mapping the sentinel lymph node in patients with breast cancer. Tumori, 86(4), 307-308.