title: [Presence of intramammary lymph nodes in the preoperative lymphoscintigraphy to locate the sentinel lymph node. Clinical significance].
abstract: OBJECTIVE
  The routes of lymphatic drainage from a breast cancer are the axilla (the most frequent) and the extra axillary regions. Among the latter, there are the so-called intrammamary lymph nodes (IMLN). This study has aimed to assess the incidence of IMLNs in our patients and study the evolution of these cases with IMLN in the lymphoscintigraphy.
  
  
  METHODS
  Thirty-eight patients (out of 1725) with IMLN in the pre-operative lymphoscintigraphy were assessed. During the surgical procedure, using a gamma probe, IMLNs were located and excised. After their harvesting, a meticulous surgical field scan was performed. When the axillary sentinel node was positive for metastasis, a complete axillary lymphadenectomy was performed. In those where the axillary sentinel node was negative and IMLN was positive (IMLN+), axillary lymphadenectomy was also performed, except for one case.
  
  
  RESULTS
  Thirty-four out of the 38 IMLNs were obtained (89.5%), because no lymphatic tissue was found in pathology analysis in three cases (8%) and in one patient (3%) IMLN was not found during surgery. Ten (26%) metastatic IMLNs were located and the remaining 24 IMLNs cases (63%) were metastasis-free. During the clinical follow-up, one patient with IMLN+ developed hepatic metastases. The remaining 33 patients did not present any recurrence. No follow-up data were available for three patients.
  
  
  CONCLUSIONS
  IMLN and axillary sentinel node biopsy are recommended when both are depicted in preoperative lymphoscintigraphy. The axilla treatment will only depend on the axillary sentinel node status. Based on the data from other authors and our own experience, avoiding the axillary lymphadenectomy when a metastatic IMLN without axillary involvement seems reasonable.
authors.affiliation: Servei de Medicina Nuclear (CDI), Hospital Clínic, Barcelona, España; Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias (HUCA), Oviedo, España.
authors.forename: Z
authors.initials: Z
authors.lastname: Nogareda
authors.affiliation: Servei de Medicina Nuclear (CDI), Hospital Clínic, Barcelona, España; Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias (HUCA), Oviedo, España.
authors.forename: A
authors.initials: A
authors.lastname: Álvarez
authors.affiliation: Servei de Medicina Nuclear (CDI), Hospital Clínic, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Perlaza
authors.affiliation: Servei d'Obstetricia i Ginecologia (ICGON), Hospital Clínic, Barcelona, España.
authors.forename: F X
authors.initials: FX
authors.lastname: Caparrós
authors.affiliation: Servei d'Obstetricia i Ginecologia (ICGON), Hospital Clínic, Barcelona, España.
authors.forename: I
authors.initials: I
authors.lastname: Alonso
authors.affiliation: Servei de Medicina Nuclear (CDI), Hospital Clínic, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Paredes
authors.affiliation: Servei de Medicina Nuclear (CDI), Hospital Clínic, Barcelona, España. Electronic address: svidal@clinic.ub.es.
authors.forename: S
authors.initials: S
authors.lastname: Vidal-Sicart
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000556:secondary*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000556:secondary; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy; D008875:Middle Aged; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging*; D021701:Sentinel Lymph Node Biopsy
keywords: Breast cancer; Cáncer de mama; Ganglio centinela; Ganglios intramamarios; Intramammary nodes; Linfogammagrafía; Lymphoscintigraphy; Sentinel node