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Internal Mammary Sentinel Lymph Node Biopsy With Modified Injection Technique: High Visualization Rate and Accurate
Peng-Fei Qiu1, Bin-Bin Cong, Rong-Rong Zhao
1From the Breast Cancer Center (PFQ, BBC, RRZ, YBL, PC, YSW) and Department of Nuclear Medicine (GRY), Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
Medicine
|October 16, 2015
Summary
A modified injection technique significantly improves internal mammary sentinel lymph node biopsy (IM-SLNB) visualization rates. This advancement enables routine IM-SLNB for better patient staging and treatment decisions, particularly in cases with positive axillary lymph nodes.
Area of Science:
- Oncology
- Surgical Oncology
- Nuclear Medicine
Background:
- The American Joint Committee on Cancer recommends internal mammary sentinel lymph node biopsy (IM-SLNB), but low visualization rates hinder surgical practice.
- Traditional radiotracer injection techniques have limited the effectiveness of IM-SLNB.
Purpose of the Study:
- To evaluate various injection techniques for improving internal mammary sentinel lymph node visualization rates.
- To analyze the impact of IM-SLNB on diagnostic and prognostic value.
Main Methods:
- Compared traditional peritumoral intraparenchymal injection (Group A) with modified periareolar intraparenchymal injection (Group B) in axillary lymph node-negative patients.
- Further stratified Group B into low (B1) and high (B2) injection volumes; ALN-positive patients were managed as Group B2.
- Performed IM-SLNB for patients with visualized internal mammary sentinel lymph nodes (IMSLN).
Main Results:
- The modified periareolar injection technique (Group B) significantly increased IMSLN visualization rates (71.1%) compared to the traditional method (Group A, 15.5%).
- High injection volume in Group B2 further improved visualization (75.1%) compared to low volume in Group B1 (45.8%).
- IM-SLNB revealed metastasis in 8.1% of clinically ALN-negative patients and 20.5% of clinically ALN-positive patients, influencing treatment decisions.
Conclusions:
- A modified periareolar intraparenchymal injection technique, particularly with high volume and ultrasound guidance, significantly enhances IMSLN visualization.
- Routine IM-SLNB is now feasible, offering individual minimally invasive staging and prognostic information.
- IM-SLNB aids in personalized treatment decisions, especially for internal mammary radiotherapy in clinically ALN-positive patients.
