Axillary lymph node drainage pathways from intradermal and intraparenchymal breast planes.
BACKGROUND
To compare functional anatomy of breast peri-areolar and peri-tumoral lymphatic drainage basins.


METHODS
Fifteen breast cancer patients received simultaneous peri-areolar (intradermal) and peri-tumoral (intraparenchymal) injections of human polyclonal immunoglobulin (HIG) labeled with (99m)Tc and (111)In 2 to 4 h before axillary lymph node clearance surgery. Resected nodes (range 5-20; median 16) were individually counted for (99m)Tc and (111)In in a well-counter and ranked according to activity content (echelon). Activity in distal nodes was negligible so extraction efficiency (E) of HIG in the first echelon node was calculated as counts divided by total counts in the chain.


RESULTS
Five- to 10-fold more activity was recovered after intradermal injection. The injection planes identified the same first echelon node in 10 patients (group 1) but different in five (group 2). In group 1, intradermal E correlated with intra-parenchymal E (r = 0.82; P < 0.01). E of intradermal first echelon nodes in group 2 was 51 (SD 13)%, similar to intradermal E in group 1 (58 [23]%). E of intraparenchymal first echelon nodes in group 2, however, was 28 (6)%, lower than intraparenchymal E in group 1 (54 [20]%; P < 0.02).


CONCLUSIONS
Lymph nodes extract approximately 50% of HIG. Extracted HIG does not cascade to distal nodes, validating HIG for sentinel node lymphoscintigraphy. HIG injected intradermally at the areola drains via a single route to the axilla. In two-thirds of patients, peri-tumoral HIG follows a similar route, but in one-third of patients drainage from the parenchymal plane is more complex, with more than one route to the axilla.
Fowler
J Charlotte
JC
Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
Solanki
Chandra K
CK
Ballinger
James R
JR
Ravichandran
Duraisamy
D
Douglas-Jones
Anthony
A
Lawrence
David
D
Bobrow
Lynda
L
Purushotham
Arnie D
AD
Peters
A Michael
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001940:Breast / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000502:physiology; D042601:Lymphatic Vessels / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology; D008875:Middle Aged; D011877:Radionuclide Imaging