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THE EUROPEAN JOURNAL OF
lymphology
and related problems
VOLUME 29 • No. 75 • 2017
INDEXED IN EXCERPTA MEDICA
DERMAL BACKFLOW APPEARANCE IN BREAST CANCER LYMPHOSCINTIGRAPHY: REPORT OF TWO CASES
ELAHE PIRAYESH, M.D. 1, HAMIDREZA HASHEMIFARD, M.D. 2
1 Nuclear Medicine Department, Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences
2 Oncology Department, Vaseie Medical Center, Sabzevar University of Medical Sciences
Corresponding author: Elahe Pirayesh, M.D.
Assistant professor of nuclear medicine, Nuclear Medicine Department,
Shohada-e Tajrish Medical Center, Shahid Beheshti University of Medical Sciences.
Address: Nuclear Medicine Department, Shohada-e Tajrish Medical Center, Tajrish Sq, Tehran, Iran. Tel: +982122723263; Fax: +982122723263
Email: elahe_pirayesh@yahoo.com
ABSTRACT
We report two cases of breast cancer who were referred to the nuclear medicine department for sentinel lymph node mapping before surgery. Imaging performed after intradermal injection of 99mTc-phytate in periareolar region. Unexpectedly, dermal backflow appearance was found. At final histology lymph node involvement and lymphatic vessels invasion was confirmed.
Keyword: breast cancer, sentinel node, lymphoscintigraphy INTRODUCTION
Axillary node status is an important prognostic factor in early breast cancer. Lymphoscintigraphy has been recognized as the modality of choice for lymph node staging. After injection of radiotracer, imaging is recommended to confirm axilla and/or extra-axillary location of sentinel lymph nodes (SLN) [1]. There are several reports which explain unusual pattern of lymphatic drainage of patients with breast cancer, in which atypical location of SLNs were found. [2-4]
In the current paper, we describe two breast cancer patients who underwent preoperative lymphoscintigarphy and showed diffuse distribution of radiotracer with faint visualization of SLNs.
CASE REPORT
Case 1
A 40 year-old female known case of invasive ductal carcinoma of right breast, diagnosed by core needle biopsy, and clinically negative axillary nodes was referred to our department for sentinel nod mapping. On physical examination, in addition of palpable
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
breast mass, the right breast was slightly denser than the left one but no evidence of erythm was noted. After intradermal injection of 0.2 ml of 1 mCi 99mTc-phytate into the peri-areolar area of the quadrant, the patient was advised to do gentle massage to the injection site for 5 minutes. Fifteen minutes after injection, anterior, lateral and oblique spot views were obtained, (3min/image, 128×128matrix) using a single head gamma camera (E.CAM Siemens), equipped with a parallel hole low energy high resolution (LEHR) collimator. Scintigarm demonstrated abnormal lymphatic transit and absence of tracer localization in the axillary lymph nodes. In addition, inversion of lymph flow and diffusion of tracer resulted in cutaneous accumulation of tracer
(dermal backflow appearance) was also seen (Fig. 1). Because of non-visualization of sentinel nodes delayed images were obtained up to 2 hours and finally on the lateral view two nodes were seen. In the operating room, two sentinel nodes were found and frozen sections were in favor of metastatic involvement. The patient underwent right breast mastectomy and right axillary lymph node dissection. At final histology, two sentinel nodes as well as were metastatic.
Fig. 1 - Scintigram shows dermal backflow appearance, with two faint SLNs.
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