title: Intra-individual comparison of lymphatic drainage patterns using subareolar and peritumoral isotope injection for breast cancer.
abstract: BACKGROUND
  Controversy exists in the literature regarding the optimal site for lymphatic mapping in breast cancer. This study was designed to characterize lymphatic drainage patterns within the same patient after subareolar (SA) and peritumoral (PT) radiopharmaceutical injections and examine the impact of reader interpretation on reported drainage.
  
  
  METHODS
  In this prospective trial, 27 women with breast cancer underwent sequential preoperative SA and PT injections of 0.5 to 2.7 mCi of technetium-99 m filtered sulfur colloid 3 days or more apart. Patterns of radiopharmaceutical uptake were reviewed independently by two nuclear medicine physicians. Inter-reader agreement and injection success were assessed in conjunction with observed drainage patterns.
  
  
  RESULTS
  There was near perfect inter-reader agreement observed on identification of axillary LN drainage after PT injection (P = 0.0004) and substantial agreement with SA injection (P = 0.0344). SA injection was more likely to drain to only axillary LNs, whereas PT injection appeared more likely to drain to both axillary and extra-axillary LNs, although no statistically significant differences were found. All patients with extra-axillary drainage after PT injection (n = 6 patients) had only axillary drainage after SA injection. Dual drainage was observed for six patients with PT injection and one patient with SA injection.
  
  
  CONCLUSIONS
  Our findings suggest that radiopharmaceutical injected in the SA location has a high propensity to drain to axillary LNs only. After controlling for patient factors and demonstrating inter-reader agreement, the inability to demonstrate statistically significant differences in drainage based on injection site suggests that lymphatic drainage patterns may be a function of patient and tumor-specific features.
authors.affiliation: Department of Plastics-Reconstructive Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Regina M
authors.initials: RM
authors.lastname: Fearmonti
authors.forename: Isis W
authors.initials: IW
authors.lastname: Gayed
authors.forename: Edmund
authors.initials: E
authors.lastname: Kim
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Barry
authors.initials: B
authors.lastname: Feig
authors.forename: Elham
authors.initials: E
authors.lastname: Ghonimi
authors.forename: Carla
authors.initials: C
authors.lastname: Warneke
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D007267:Injections; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015996:Survival Rate; D013671:Technetium Tc 99m Sulfur Colloid; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid
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