Radionuclide lymphoscintigraphy performed on the mastectomized chest wall

Area of Science:

• Oncology
• Nuclear Medicine
• Surgical Oncology

Background:

• Understanding lymphatic drainage patterns in the anterior chest wall is crucial for effective breast cancer treatment.
• Post-mastectomy patients may exhibit altered lymphatic flow, influencing recurrence risk and treatment strategies.

Purpose of the Study:

• To investigate lymphatic flow dynamics in the anterior chest wall of patients treated for breast carcinoma.
• To assess the visualization of contralateral axillary lymph nodes using lymphoscintigraphy.
• To correlate lymphatic drainage patterns with local chest wall recurrence and guide radiotherapy field design.

Main Methods:

• Lymphoscintigraphy was performed on 64 breast carcinoma patients using 99mTc-rhenium colloid.
• Intradermal injection of radionuclides was administered along surgical wounds.
• Scintigraphic images were analyzed for lymphatic visualization, particularly of contralateral axillary lymph nodes, at 4 hours post-injection.

Main Results:

• Contralateral axillary lymph nodes were frequently visualized, especially in patients with local chest wall recurrence (13 out of 20).
• Stimulated lymphatic flow around local recurrence sites was observed.
• Faint lymphatic drainages to contralateral axillary lymph nodes were identified from various anterior chest wall levels.

Conclusions:

• Lymphatic flow can extend to contralateral axillary lymph nodes in breast carcinoma patients, particularly with recurrence.
• Radiotherapy fields should encompass downstream lymphatic pathways to improve treatment efficacy.
• Postoperative irradiation may impair radionuclide accumulation in lymph nodes after radiotherapy completion.