title: Validation study for the hypothesis of internal mammary sentinel lymph node lymphatic drainage in breast cancer.
abstract: According to axilla sentinel lymph node lymphatic drainage pattern, we hypothesized that internal mammary sentinel lymph node (IM-SLN) receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma. Based on the hypothesis a modified radiotracer injection technique was established and could increase the visualization rate of the IM-SLN significantly. To verify the hypothesis, two kinds of tracers were injected at different sites of breast. The radiotracer was injected with the modified technique, and the fluorescence tracer was injected in the peritumoral intra-parenchyma. The location of IM-SLN was identified by preoperative lymphoscintigraphy and intraoperative gamma probe. Then, internal mammary sentinel lymph node biopsy (IM-SLNB) was performed. The fluorescence status of IM-SLN was identified by the fluorescence imaging system. A total of 216 patients were enrolled from September 2013 to July 2015. The overall visualization rate of IM-SLN was 71.8% (155/216). The success rate of IM-SLNB was 97.3% (145/149). The radiotracer and the fluorescence tracer were identified in the same IM-SLN in 127 cases, the correlation and the agreement is significant (Case-base, rs=0.836, P<0.001; Kappa=0.823, P<0.001). Different tracers injected into the different sites of the intra-parenchyma reached the same IM-SLN, which demonstrates the hypothesis that IM-SLN receives the lymphatic drainage from not only the primary tumor area but also the entire breast parenchyma.
authors.affiliation: School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan, Shandong, China.|Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Bin-Bin
authors.initials: BB
authors.lastname: Cong
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Qiu
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Yan-Bing
authors.initials: YB
authors.lastname: Liu
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Zhao
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Chen
authors.affiliation: School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan, Shandong, China.|Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Xiao-Shan
authors.initials: XS
authors.lastname: Cao
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Chun-Jian
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Zhao-Peng
authors.initials: ZP
authors.lastname: Zhang
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Yu
authors.affiliation: Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China.
authors.forename: Yong-Sheng
authors.initials: YS
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D005456:Fluorescent Dyes / Q000737:chemistry; D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry; D007455:Iodine / Q000737:chemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007455:Iodine; D007208:Indocyanine Green
keywords: breast cancer; indocyanine green; internal mammary; sentinel lymph node biopsy; visualization rate