Cancer Res Treat.  2019 Apr;51(2):483-492. 10.4143/crt.2018.062.

The Lymphatic Drainage Pattern of Internal Mammary Sentinel Lymph Node Identified by Small Particle Radiotracer ((99m)Tc-Dextran 40) in Breast

• Cao XS
• Yang GR
• Cong BB
• Qiu PF
• Wang YS

• KMID: 2464395
• DOI: http://doi.org/10.4143/crt.2018.062

Abstract

PURPOSE
The purpose of this study was to detect the lymphatic drainage pattern of internal mammary area and verify the concept of internal mammary sentinel lymph node (IM-SLN) in breast.
MATERIALS AND METHODS
A small particle radiotracer ((99m)Tc-Dextran 40) was prepared and tested. (99m)Tc-Dextran 40 was injected into intraparenchyma at the sound breast by a modified radiotracer injection technique. Subsequently, dynamic single-photon emission computed tomography (SPECT), computed tomography (CT), and SPECT/CT combination images were performed to identify the radioactive lymph vessels and internal mammary lymph nodes (IMLNs). The direction of lymph drainage and the location of the IMLNs were identified in the SPECT/CT imaging.
RESULTS
The radiochemical purity of (99m)Tc-Dextran 40 was > 95%. (99m)Tc-Dextran 40 could drainage into first, second, and third lymph node and the radioactive lymph node could be detected by the γ detector in the animal experiment. After (99m)Tc-Dextran 40 injecting into intraparenchyma, 50.0% cases (15/30) were identified the drainage lymphatic vessels and radioactive IMLNs by SPECT. The drainage lymphatic vessel was found from injection point to the first IMLN (IM-SLN) after 10.5±0.35 minutes radiotracer injection, and then (99m)Tc-Dextran 40 was accumulated into the IM-SLN. The combination imaging of SPECT/CT showed the second IMLN received the lymph drainage from the IM-SLN. The lymphatic drainage was step by step in the internal mammary area.
CONCLUSION
The lymph was identified to drain from different regions of the breast to IM-SLN, and then outward from IM-SLN to other IMLN consecutively. It demonstrated the concept of the IM-SLN and provided more evidences for the application of internal mammary sentinel lymph node biopsy.

Keyword

Breast neoplasms; Lymph drainage; Internal mammary sentinel lymph node; (99m)Tc-Dextran 40; SPECT/CT

MeSH Terms

Animal Experimentation
Breast Neoplasms
Breast*
Drainage*
Lymph Nodes*
Lymphatic Vessels
Sentinel Lymph Node Biopsy
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon

Figure

• 

  Fig. 1. The lymphatic drainage identified by blue dye in the hind foot of the mice. a, injection point; b, sentinel lymph node (popliteal); c, secondary lymph node (iliac); d, tertiary lymph node (renal).

• 

  Fig. 2. The single-photon emission computed tomography images of dynamic lymphoscintigraphy. The small particle radiotracer could be identified in the lymphoscintigraphy with the time going. R, right breast is the tumor side; L, left breast is the sound side; IMLN, internal mammary lymph node; ALN, axillary lymph node; ASLN, axillary sentinel lymph node.

• 

  Fig. 3. The combination images of single-photon emission computed tomography (SPECT)/computed tomography (CT) which helps to identify the intercostal location of internal mammary lymph nodes (IMLNs) from different anatomical aspects. ASLN, axillary sentinel lymph node.

• 

  Fig. 4. The lymphoscintigraphy detected by the single-photon emission computed tomography (SPECT)/computed tomography (CT) in the next day morning about 1 hour before surgery. IMLN, internal mammary lymph node; ASLN, axillary sentinel lymph node; SCLN, supraclavicular lymph node.

• 

  Fig. 5. The lymph in different area drain into the same internal mammary lymph node (IMLN), and then other IMLNs receive lymph from it one by one.

• 

  Fig. 6. The lymph in different area of breast drain into different internal mammary lymph nodes.

Reference

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