title: Lymphatic drainage pathways of the breast and the upper limb.
abstract: OBJECTIVE
  To determine how often the sentinel lymph node (SLN) draining the breast is the same node as the SLN draining the upper limb. A common SLN might increase the risk of upper limb breast cancer-related lymphoedema after SLN biopsy.
  
  
  METHODS
  Patients with invasive breast cancer, identified as being suitable for axillary lymph node dissection, were injected preoperatively with 40 MBq of technetium-99m (Tc)-human polyclonal immunoglobulin G intradermally into the ipsilateral breast and 3 MBq of indium-111 (In)-human polyclonal immunoglobulin G intradermally into the ipsilateral hand, or vice versa. Axillary lymph nodes were removed, separated and assayed in a well counter for Tc and In.
  
  
  RESULTS
  Fifteen patients entered the study. In 13 of 15 patients, the 'hottest' lymph node for Tc was separate from the 'hottest' lymph node for In. In two of 15 patients the 'hottest' lymph node for Tc was also the 'hottest' lymph node for In, suggesting a common drainage pathway from the ipsilateral breast and upper limb.
  
  
  CONCLUSIONS
  Although the majority of patients has different pathways of lymphatic drainage from the ipsilateral breast and upper limb, in a small minority of patients the drainage pathway is through a common SLN. Such patients may be at increased risk of developing upper limb breast cancer-related lymphoedema after SLN biopsy.
authors.affiliation: Department of Academic Oncology, King's College London, UK.
authors.forename: Tom Bennett
authors.initials: TB
authors.lastname: Britton
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Solanki
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Pinder
authors.forename: Peter S
authors.initials: PS
authors.lastname: Mortimer
authors.forename: A Michael
authors.initials: AM
authors.lastname: Peters
authors.forename: Anand D
authors.initials: AD
authors.lastname: Purushotham