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Validation study of the modified injection technique for internal mammary sentinel lymph node biopsy in breast cancer.

Cong BB, Cao XS, Qiu PF, Liu YB, Zhao T, Chen P, Wang CJ, Zhang ZP, Sun X, Wang YS - Onco Targets Ther (2015)

Bottom Line: To verify the accuracy of the hypothesis and validate the modified radiotracer injection technique and to observe whether the lymphatic drainage of the whole breast parenchyma could reach to the same IM-SLN, different tracers were injected into different locations of the breast.The validation study results showed that the correlation and the agreement of the radiotracer and the fluorescence tracer are significant (case-base, r s =0.808, P<0.001; Kappa =0.79, P<0.001).It proved that the lymphatic drainage from different location of the breast (the primary tumor, the subareolar plexus) reached the same IM-SLNs and the hypothesis of IM-SLN lymphatic drainage pattern (ie, IM-SLN receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma).

View Article: PubMed Central - PubMed

Affiliation: Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan University-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; School of Medicine and Life Sciences, Jinan University-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.

ABSTRACT
According to the hypothesis of internal mammary sentinel lymph node (IM-SLN) lymphatic drainage pattern, a modified radiotracer injection technique (periareolar intraparenchyma, high volume, and ultrasonographic guidance) was established. To verify the accuracy of the hypothesis and validate the modified radiotracer injection technique and to observe whether the lymphatic drainage of the whole breast parenchyma could reach to the same IM-SLN, different tracers were injected into different locations of the breast. The validation study results showed that the correlation and the agreement of the radiotracer and the fluorescence tracer are significant (case-base, r s =0.808, P<0.001; Kappa =0.79, P<0.001). It proved that the lymphatic drainage from different location of the breast (the primary tumor, the subareolar plexus) reached the same IM-SLNs and the hypothesis of IM-SLN lymphatic drainage pattern (ie, IM-SLN receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma). In other words, it validated the accuracy of our modified radiotracer injection technique.

No MeSH data available.


Related in: MedlinePlus

Flowchart of the validation study.Abbreviations: ICG, indocyanine green; IM-SLNB, internal mammary sentinel lymph node biopsy.
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f3-ott-8-2705: Flowchart of the validation study.Abbreviations: ICG, indocyanine green; IM-SLNB, internal mammary sentinel lymph node biopsy.

Mentions: A total of 156 patients with breast cancer were enrolled in this study from September 2013 to December 2014. The radiotracer (99mTc-labeled sulfur colloid, 1.0–1.2 mL, 9.25–18.5 MBq) was injected with our modified radiotracer injection technique, and the injection sites were chosen at the 6 and 12 o’clock positions, 0.5–1.0 cm from the areola, under ultrasonographic guidance 3–18 hours before surgery.7 All patients underwent a preoperative lymphoscintigraphy (Toshiba GCA 901AHG; Toshiba, Tokyo, Japan) 30 minutes before surgery and a gamma probe (Neoprobe, Neo2000 gamma detection system; Johnson & Johnson New Brunswick, NJ, USA) detection 10 minutes before surgery. Radioactive IM-SLNs was defined as IM-SLNs visualized on preoperative lymphoscintigraphy (Figure 1) and detected by gamma probe. Patients with radioactive IM-SLNs were injected with ICG 5 minutes before surgery. A total of 2 mL 0.5% ICG was intraparenchymally injected under the ultrasonographic guidance at the peritumoral near the subareolar region to differentiate it from the radiotracer. IM-SLNB was performed for patients with the radioactive IM-SLNs. The fluorescent signal of IM-SLN was identified by the fluorescence imaging system (Mingde, MD fluorescence imaging system, Langfang, People’s Republic of China; Figure 2). The flowchart of the validation study is shown in Figure 3.


Validation study of the modified injection technique for internal mammary sentinel lymph node biopsy in breast cancer.

Cong BB, Cao XS, Qiu PF, Liu YB, Zhao T, Chen P, Wang CJ, Zhang ZP, Sun X, Wang YS - Onco Targets Ther (2015)

Flowchart of the validation study.Abbreviations: ICG, indocyanine green; IM-SLNB, internal mammary sentinel lymph node biopsy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4590635&req=5

f3-ott-8-2705: Flowchart of the validation study.Abbreviations: ICG, indocyanine green; IM-SLNB, internal mammary sentinel lymph node biopsy.
Mentions: A total of 156 patients with breast cancer were enrolled in this study from September 2013 to December 2014. The radiotracer (99mTc-labeled sulfur colloid, 1.0–1.2 mL, 9.25–18.5 MBq) was injected with our modified radiotracer injection technique, and the injection sites were chosen at the 6 and 12 o’clock positions, 0.5–1.0 cm from the areola, under ultrasonographic guidance 3–18 hours before surgery.7 All patients underwent a preoperative lymphoscintigraphy (Toshiba GCA 901AHG; Toshiba, Tokyo, Japan) 30 minutes before surgery and a gamma probe (Neoprobe, Neo2000 gamma detection system; Johnson & Johnson New Brunswick, NJ, USA) detection 10 minutes before surgery. Radioactive IM-SLNs was defined as IM-SLNs visualized on preoperative lymphoscintigraphy (Figure 1) and detected by gamma probe. Patients with radioactive IM-SLNs were injected with ICG 5 minutes before surgery. A total of 2 mL 0.5% ICG was intraparenchymally injected under the ultrasonographic guidance at the peritumoral near the subareolar region to differentiate it from the radiotracer. IM-SLNB was performed for patients with the radioactive IM-SLNs. The fluorescent signal of IM-SLN was identified by the fluorescence imaging system (Mingde, MD fluorescence imaging system, Langfang, People’s Republic of China; Figure 2). The flowchart of the validation study is shown in Figure 3.

Bottom Line: To verify the accuracy of the hypothesis and validate the modified radiotracer injection technique and to observe whether the lymphatic drainage of the whole breast parenchyma could reach to the same IM-SLN, different tracers were injected into different locations of the breast.The validation study results showed that the correlation and the agreement of the radiotracer and the fluorescence tracer are significant (case-base, r s =0.808, P<0.001; Kappa =0.79, P<0.001).It proved that the lymphatic drainage from different location of the breast (the primary tumor, the subareolar plexus) reached the same IM-SLNs and the hypothesis of IM-SLN lymphatic drainage pattern (ie, IM-SLN receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma).

View Article: PubMed Central - PubMed

Affiliation: Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan University-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; School of Medicine and Life Sciences, Jinan University-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.

ABSTRACT
According to the hypothesis of internal mammary sentinel lymph node (IM-SLN) lymphatic drainage pattern, a modified radiotracer injection technique (periareolar intraparenchyma, high volume, and ultrasonographic guidance) was established. To verify the accuracy of the hypothesis and validate the modified radiotracer injection technique and to observe whether the lymphatic drainage of the whole breast parenchyma could reach to the same IM-SLN, different tracers were injected into different locations of the breast. The validation study results showed that the correlation and the agreement of the radiotracer and the fluorescence tracer are significant (case-base, r s =0.808, P<0.001; Kappa =0.79, P<0.001). It proved that the lymphatic drainage from different location of the breast (the primary tumor, the subareolar plexus) reached the same IM-SLNs and the hypothesis of IM-SLN lymphatic drainage pattern (ie, IM-SLN receives lymphatic drainage from not only the primary tumor area, but also the entire breast parenchyma). In other words, it validated the accuracy of our modified radiotracer injection technique.

No MeSH data available.


Related in: MedlinePlus