LYMPHATIC PATHWAYS OF THE UPPER MEDIAL QUADRANT OF THE BREAST IN HEALTHY WOMEN: RADIOTRACER STUDY OF THE SENTINEL LYMPH NODE

Abstract

This study examined the lymphaticdrainage after injection ofa radiotracer intothe upper medial quadrant of the breast inhealthy women. Most studies of lymphaticpathways of the breast have been performed inpatients with breast cancer and concentrateon the upper lateral quadrant of the breastbecause of the high incidence of carcinoma atthis site. The lymphatic drainage pathways ofthe medial half of the breast, however, hasbeen less studied. A radiotracer (Tc-99mhuman serum albumin nanocolloid or HSA)was injected intradermally into the uppermedial quadrant of the right breast in 12healthy women. Dermal markers were placedat the middle of the clavicle, the axilla and atthe jugular incisura. Three minutes afterinjection a static image of the injection sitewas made with a scintillation camera(Multispect 2 Gamma Camera System) over20 seconds. After nine minutes, local softmassage was instituted at the injection site for6 minutes. Fifteen minutes after injection, agraphic scintigraphic image was made of bothbreasts and axillae over 22 minutes. After thisinterval, three or four static images were madefor a few seconds to locate the sentinel lymphnode as related to the injection site.A sentinel lymph node (lymphaticpathway) in the axilla was visualized in 11subjects (91.9%) and was undetected in onesubject (8.3%). The radiotracer migrated in allpatients (100% ) towards the ipsilateral axilla.In 9 subjects, the sentinel lymph node wasvisualized 15 minutes after injection, whereasin 2 subjects it appeared within an hour.