Lymphatic mapping in patients with primary or recurrent breast cancer following previous axillary surgery

To evaluate the feasibility of lymphatic mapping in breast cancer patients after previous axillary surgery and to identify parameters associated with mapping failure.

Lymphatic mapping using peritumoural injection of blue dye and a radiocolloid was attempted in 30 patients with primary (n=7) or recurrent (n=23) breast cancer and a history of previous axillary lymph node dissection or sentinel node biopsy.

Lymphatic mapping identified a mean number of 1.6 (range 1-3) lymph nodes in 19 of 30 patients (identification rate 63%). The lymph nodes were removed from the ipsilateral axilla (n=13), the internal mammary chain (n=2), both the internal mammary nodes and the axilla (n=2), the interpectoral space (n=1) and the contralateral axilla (n=1). Four of 19 patients revealed a positive lymph node. Fifteen of 19 patients had a negative lymph node. Axillary lymph node dissection was done in 13 of 15 patients but found no positive nodes (false negative rate=0). A negative lymphoscintigram (p<0.001) and a number of more than 10 lymph nodes removed at the time of initial surgery (p=0.02) were significantly associated with a mapping failure.

Lymphatic mapping following prior axillary surgery was accurate but associated with a low identification rate. The lymphatic drainage pattern was unpredictable and the use of a radionuclide was necessary for a successful mapping procedure.