Mammary Lymphoscintigraphy

A variety of studies were performed using mammary lymphoscintigraphy with the aim of diagnosing nodal metastases in patients with breast cancer. Tracers were administered in various parts of the breast.

In 1981, Gabelle and colleagues studied intratumoral injection of the tracer in 100 patients with breast cancer and counted the number of nodes seen 4 h later on scan [61]. They found that patients with nodal metastases had fewer nodes visualized on average than those who were free of metastases, but the results were not useful in individual patients.

Serin and colleagues studied 51 patients to determine the accuracy of mammary lymphoscintigraphy with intratumoral injection in diagnosing nodal metastases, comparing the scans with clinical examination of the axilla and pathology [62]. They found this technique to be of no value.

Gasparini and colleagues used periareolar injection of radiocolloid in 26 patients with breast cancer and again scans were performed in the search for metastases [63]. The number of nodes visualized in the axilla was compared to pathology, but no useful data were obtained.

A modification of the above technique was used by Mazzeo and co-workers, who administered subareolar injections in 32 patients and scanned the axilla for metastases [64]. The method proved inadequate.

Terui and Yamamoto studied 100 patients with breast cancer using subperi-osteal injections of radiocolloid and demonstrated both internal mammary and axillary drainage in most patients [65]. They used the test to roughly locate the lymph nodes and to evaluate them for metastases. However, it is unclear how the observed lymph drainage patterns were expected to relate to the lymphatic drainage of the actual breast tumors.

Intradermal injection around the surgical wound following surgical removal of a breast cancer was used by Matsubara and colleagues [66]. They found that the contralateral axillary nodes were often visualized as well as nodes in the ipsilateral axilla. These data seem of doubtful relevance to the breast tumor lymphatic drainage, as the method was clearly evaluating dermal lymphatic drainage, not the breast lymphatics. In any case, the dermal lymphatic pathways are likely to have been altered significantly by the prior surgery on the breast.

Saeki and colleagues studied 12 patients with breast tumors and injected labeled microspheres into the breast tissue at unspecified locations [67]. They observed tracer in axillary, subclavian, and parasternal lymph nodes in 10 patients 1 h after injection.

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