title: A novel finding of sentinel lymphatic channels in early stage breast cancer patients: which may influence detection rate and false-negative rate of sentinel lymph node biopsy.
abstract: BACKGROUND
  The exact lymphatic drainage pattern of the breast hasn't been explained clearly. The aim of this study was to investigate the sentinel lymphatic channels (SLCs) in the cancerous breast. Whether the type of SLCs influenced the detection rate and false-negative rate of SLNB was also assessed.
  
  
  RESULTS
  Mimic SLNB was performed in 110 early-stage breast cancer patients with subareolar injection of blue methylene dye intraoperatively. Postoperatively, 110 specimens of modified radical mastectomy were examined for all blue SLCs after additional injection of methylene dye in peritumoral parenchyma. Interestingly, three types of SLCs, including superficial sentinel lymphatic channel (SSLC), deep sentinel lymphatic channel (DSLC), and penetrating sentinel lymphatic channel (PSLC) were found in 107 patients. Six lymphatic drainage patterns based on the three types of SLCs were observed in these 107 patients. The proportions of the drainage pattern SSLC, DSLC, PSLC, SSLC+DSLC, SSLC+PSLC, and DSLC+PSLC in the breast were 43%, 0.9%, 15.9%, 33.6%, 3.7% and 2.8%, respectively. The lymphatic drainage pattern in the breast was a significant risk factor for unsuccessful identification of sentinel lymph nodes (P<0.001) and false-negatives in SLNB (P = 0.034) with the subareolar injection technique.
  
  
  CONCLUSIONS
  Three kinds of SLCs are the basis of six lymphatic drainage patterns from the breast to the axilla. The type of SLCs is the factor influencing the detection rate and false-negative rate of SLNB. These findings suggest the optimal injection technique of the combination of superficial and deep injection in SLNB procedures. Future clinical studies are needed to confirm our novel findings.
authors.affiliation: Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Minghai
authors.initials: M
authors.lastname: Wang
authors.forename: Wenbin
authors.initials: W
authors.lastname: Zhou
authors.forename: Yingchun
authors.initials: Y
authors.lastname: Zhao
authors.forename: Tiansong
authors.initials: T
authors.lastname: Xia
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zha
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
authors.forename: Xiaoan
authors.initials: X
authors.lastname: Liu
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhao
authors.forename: Lijun
authors.initials: L
authors.lastname: Ling
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
authors.forename: Shui
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D001365:Axilla / Q000473:pathology; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D003710:Demography; D004322:Drainage; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy