A modified technology could significantly improve the visualization rate of the internal mammary sentinel lymph nodes in
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LETTER TO THE EDITOR
A modified technology could significantly improve the visualization rate of the internal mammary sentinel lymph nodes in breast cancer patients Peng-fei Qiu • Juan-juan Liu • Yan-bing Liu • Guo-ren Yang • Xiao Sun • Yong-sheng Wang
Received: 26 July 2012 / Accepted: 8 August 2012 / Published online: 6 September 2012 Springer Science+Business Media, LLC. 2012
To the Editor, In addition to the axillary lymph nodes, the internal mammary lymph nodes (IMLNs) drainage is another important lymphatic channel of the breast. The status of IMLNs also provides important prognostic information for breast cancer patients. However, there still lack a minimally invasive method to evaluate the status of IMLNs so far. We read with great interest the work of Postma and colleagues published recently [1], where the authors showed that the biopsy of internal mammary sentinel lymph nodes (IM-SLNs) when seen on pre-operative lymphoscintigraphy provided a less invasive method of assessing the IMLNs than surgical dissection; however, in the group of patients who underwent the biopsy of IM-SLNs, systemic treatment was changed in none. It is important to realize that the internal mammary hotspots in lymphoscintigraphy were seen only in 119 of 486 (24 %) patients with four peritumoral injections in Postma’s study. As Chen et al. [2] summarized, superficial injection of radionuclide was unable to identify IM-SLNs but intraparenchymal injection (peritumoral, intratumoral, or subtumoral) was more reliable. Unfortunately, with this injection method, the internal
P. Qiu Y. Liu X. Sun Y. Wang (&) Breast Cancer Center, Shandong Cancer Hospital, 440 Jiyan Rd, Jinan, 250117 Shandong, People’s Republic of China e-mail: [email protected] J. Liu G. Yang Department of Nuclear Medicine, Shandong Cancer Hospital, Jinan, Shandong, People’s Republic of China
mammary hotspots in lymphoscintigraphy were seen only in a small proportion of patients (range from 13 to 37 %), which has been the restriction for the biopsy of IM-SLNs to date [2–4]. Mudun et al. [5] showed that internal mammary hotspots were more frequently seen in patients receiving four-point peritumoral injections compared with one-point injection (22.2 vs 8.4 %). They speculated that radionuclide might be better uptaken by IM-SLNs if more than one-point peritumoral injection was performed. For this reason, we tried injecting radionuclide into two quadrants of the breast to achieve a relative high detection rate of IM-SLNs. To our great surprise, the visualization rate of IM-SLNs (71 %, 37/52) in lymphoscintigraphy was found to be much higher than expected with this modified technology. A study of IM-SLNB was conducted in our institute from November 2011 and a total of 110 patients were enrolled till now. 0.5–1.0 mCi 99mTc-labeled sulfur colloid (0.2–2.0 ml) was injected intraparenchymally under the ultrasonographic guidance 3–18 h before surgery. In the initial 58 cases, the patients received the sulfur colloid injection only into the tumor quadrant. In the l
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