Validation study of the modified injection technique for internal mammary sentinel lymph node biopsy in breast cancer

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A modified radiotracer injection technique is accurate for internal mammary sentinel lymph node biopsy in patients with breast cancer, a new study published in the journal OncoTargets and Therapy has shown.

Because the traditional radiotracer injection technique has a low visualization of internal mammary sentinel lymph nodes and previous internal mammary sentinel lymph node biopsy clinical trials have failed to assess the status of internal mammary lymph nodes in patients with clinically negative axillary lymph nodes, researchers at Shandong Cancer Hospital and Institute in China sought to validate a modified radiotracer injection technique for lymph node biopsy.

The modified technique consists of a high volume of 99mTc-labeled sulfur colloid radiotracer being injected into the periareolar intraparenchyma guided by ultrasonography.

Compared with the traditional technique, the modified technique was found to significantly improve the visualization rate of internal mammary sentinel lymph nodes without reducing the axillary sentinel lymph node visualization rate.

The modified technique was validated in 156 patients with breast cancer. Patients with the radioactive sentinel lymph nodes underwent internal mammary sentinel lymph node biopsy, which was successfully performed in 98.2% of patients.

According to the hypothesis of internal mammary sentinel lymph node, a modified radiotracer injection technique was established.
According to the hypothesis of internal mammary sentinel lymph node, a modified radiotracer injection technique was established.

Abstract: According to the hypothesis of internal mammary sentinel lymph node (IM-SLN) lymphatic drainage pattern, a modified radiotracer injection technique (periareolar intraparenchyma, high volume, and ultrasonographic guidance) was established.

To verify the accuracy of the hypothesis and validate the modified radiotracer injection technique and to observe whether the lymphatic drainage of the whole breast parenchyma could reach to the same IM-SLN, different tracers were injected into different locations of the breast.

The validation study results showed that the correlation and the agreement of the radiotracer and the fluorescence tracer are significant (case-base, rs =0.808, P,0.001; Kappa =0.79, P,0.001).

It proved that the lymphatic drainage from different location of the breast (the primary tumor, the subareolar plexus) reached the same IM-SLNs and the hypothesis of IM-SLN lymphatic drainage pattern (ie, IM-SLN receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma).

In other words, it validated the accuracy of our modified radiotracer injection technique.

Keywords: breast cancer, internal mammary, sentinel lymph node biopsy, visualization rate

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