title: Manual Lymphatic Drainage after Subepidermal Tracer Injection Optimizes Results of Sentinel Lymph Node Labeling in Primary Breast Cancer.
abstract: BACKGROUND
  Our aim was to assess the practicability and reliability of a novel labeling regime for axillary sentinel lymph nodes (SLNs) in early breast cancer.
  
  
  METHODS
  362 patients with early breast cancer (bilateral in 9 cases, giving a total of 371 cases) underwent intradermal radio tracer injection with simultaneous manual lymphatic drainage. SLN biopsy was performed within 24 h. For retrospective analysis, data were extracted from patient's records.
  
  
  RESULTS
  At least 1 SLN was detected intraoperatively in 369 cases (99.5%, range 1-9 nodes). This node was metastatic in 88 and unaffected in 281 cases. Coincidentally removed but unlabeled lymph nodes were affected in 3 cases in which the SLN was unaffected (3/153 = 2%). In all cases, on histological evaluation, tissue removed as SLN contained lymph nodes. After a period of 69.5 months (median 1.7-115.8 months), no axillary recurrences were observed in 213 patients.
  
  
  CONCLUSIONS
  Manual lymphatic drainage is a simple technique that leads to an extremely high pick-up rate of axillary SLNs after subepidermal radio tracer injection. If unaffected, this node correctly predicts nodal-negative disease in 98% of cases studied.
authors.affiliation: Praxisklinik am Rosengarten, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sillem
authors.affiliation: Department of Radiology and Nuclear Medicine, Kreiskrankenhaus Emmendingen, Emmendingen, Germany.
authors.forename: Urban
authors.initials: U
authors.lastname: Bromberger
authors.affiliation: Department of Obstetrics and Gynecology, Kreiskrankenhaus Emmendingen, Emmendingen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Heitzelmann
authors.affiliation: Department of Radiology and Nuclear Medicine, Kreiskrankenhaus Emmendingen, Emmendingen, Germany.
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Brauer
authors.affiliation: Institute of Clinical Pathology, University Hospital Freiburg, Freiburg i.Br., Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.affiliation: Institute of Clinical Pathology, University Hospital Freiburg, Freiburg i.Br., Germany.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Timme
keywords: Breast cancer; Manual lymphatic drainage; Sentinel node