technetium-tc-99m-sulfur-colloid and Carcinoma--Ductal

A 34-year-old woman with history of bilateral saline implants, invasive ductal carcinoma of the right breast, and suspicious left breast calcifications was referred for left breast lymphoscintigraphy before bilateral mastectomy. A total of 3.2 mCi of Tc-filtered sulfur colloid was administered with 3 subdermal injections in the superior, lateral, and inferior periareolar left breast in the late afternoon preceding the day of surgery. Imaging identified radiotracer uptake within a dense, circular area deep to the injection sites within the left breast, compatible with implant puncture and radiotracer administration within the indwelling breast implant.

Topics: Adult; Breast Implants; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Lymphoscintigraphy; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Internal mammary (IM) nodes are a potential site of breast lymphatic drainage. We examined the relationship between lymphoscintigraphic evidence of IM drainage and survival in early-stage breast cancer patients (pts).. From a prospective database of 855 consecutive sentinel node mapping procedures using peritumoral radiocolloid injection from 1996-2004, we analyzed the 604 cases with stage I-III breast cancer. Overall survival and recurrence-free survival (OS, RFS) rates were compared in pts with (IM+) and without (IM-) IM drainage on lymphoscintigraphy using Kaplan-Meier plots and Cox proportional hazards models.. 100 of 604 pts (17%) showed IM drainage. Five-year OS and RFS were 92% vs 88% and 88% vs 85% in IM- vs IM+ pts. In the 186 pts with axillary metastases (node+), 5-year OS and RFS were 91% vs 71% and 84% vs 69% in IM- vs IM+ pts. Univariate analysis of node+ pts estimated increased mortality risk for IM+ (hazard ratio, HR 2.9, P = .04), >or=4 positive nodes (HR 3.2, P = .02), tumors that were ER-negative (HR 3.4, P = .02), or had high Ki-67 (HR 6.8, P = .01). Multivariate analysis estimated similar increased risks [>or=4 nodes (HR 4.0, P = .02), IM+ (HR 3.3, P = .06), and ER negativity (HR 2.6, P = .09)].. IM nodal drainage predicted a nearly 3-fold increased mortality risk in node+ pts. Peritumoral radiocolloid injection provides a clinically relevant assessment of IM drainage and should be prospectively tested for its value in tailoring treatment strategies for axillary node-positive pts.

Topics: Adult; Aged; Axilla; Breast; Breast Neoplasms; Carcinoma, Ductal; Disease-Free Survival; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Neoplasm Staging; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Radionuclide Imaging; Risk Assessment; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

The aim of this study was to evaluate the success rate of combined peritumoral and subdermal injection techniques based on our previous experience on different injection techniques for lymphoscintigraphy.. Fifty-nine women with early breast cancer (mean tumor size, 20.5 mm) were prospectively studied. On the morning of the operation, each patient had 2 injections, one peritumoral (PT) medial to the lesion and one subdermal (SD) into the skin over the tumor quadrant. Each injection consisted of 20 MBq (540 mCi) Tc-99m rhenium sulfide colloid. Early dynamic and delayed static images were obtained up to 4 hours after injections. An intraoperative gamma probe was used to explore the axillary sentinel lymph nodes (SLN). All surgical specimens were evaluated histopathologically.. Forty patients had breast-preserving surgery and 19 had modified radical mastectomy. Thirty-eight patients had axillary dissection. All but 4 patients showed axillary lymphatic drainage. Twelve of 59 patients (20%) showed extraaxillary drainage with lymphoscintigraphy. Combined injection technique yielded a 93.2% success rate in detecting axillary SLN. In 2 of 4 patients with no drainage on lymphoscintigraphy, intraoperative gamma probe revealed SLN during the surgery. Twenty patients (33%) had positive axillary lymph nodes. In 14 of them, the SLN was the only positive node. A false-negative rate was found 1.6% (one of 59 patients).. This results suggest that a combination of both PT and SD techniques increases the success rate of visualization SLN and enhances the visualization of extraaxillary nodes for further treatment planning.

Topics: Adult; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Injections, Intralesional; Injections, Subcutaneous; Lymph Nodes; Lymphatic Metastasis; Positron-Emission Tomography; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Artifacts; Breast Implants; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid