Localization of the sentinel node of the upper outer breast quadrant in the axillary quadrants.
BACKGROUND
Sentinel node (SN) biopsy is associated with much less morbidity than axillary dissection. In patients with early breast cancer, lymphatic mapping and SN biopsy accurately stage the axillary nodes. Both currently available lymphatic mapping agents, radiocolloid and blue dye, have some limitations that may make perioperative or preoperative SN identification difficult. In such cases, exact knowledge of the topography of the axilla and the most probable location of the SN may be crucial.


METHODS
In 12 fresh female cadavers with no history of breast carcinoma, injections of patent blue dye were used to visualize the SNs in the axillary quadrants and their lymphatic collectors from the upper outer quadrant of the breast, which is the most common location of breast cancer. The axilla was divided into quadrants with regard to the intersection of the thoracoepigastric vein and the third intercostobrachial nerve.


RESULTS
All SNs were located within a circle of 2-cm radius of this intersection in the fatty tissue at the clavipectoral fascia. In most cases, the SN was located in the fatty tissue near the clavipectoral fascia in the lower ventral quadrant of the axilla (n = 14, 58%). In seven cases (29%), the SN was located in the upper ventral quadrant, in two cases (8%) in the upper dorsal quadrant, and in one case in the lower dorsal quadrant.


CONCLUSIONS
The results of this anatomical study may facilitate SN biopsy in patients with breast cancer.
Pavlista
David
D
Department of Oncogynecology, Clinic of Obstetrics and Gynecology, 1st Medical Faculty, Charles University, and General Faculty Hospital, Apolinarska 18, Prague, 12801, Czech Republic. d.pavlista@seznam.cz
Eliska
Oldrich
O
Duskova
Marketa
M
Zikan
Michal
M
Cibula
David
D
D000368:Aged; D001365:Axilla / Q000033:anatomy & histology*; D001940:Breast / Q000033:anatomy & histology; D002102:Cadaver; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology*; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D008875:Middle Aged; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
D012394:Rosaniline Dyes; C008769:sulfan blue