Unresolved issues in internal mammary sentinel lymph node biopsy for breast cancer
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説明
Lymphatic mapping and sentinel lymph node (SLN) biopsy can reliably determine axillary node status, allowing axillary dissection to be limited to patients with node-positive breast cancer. However, techniques for the administration of dye and/or radioisotope have been controversial and include intratumoral, peritumoral (intraparenchymal), intradermal, subdermal and subareolar injection. Since the first step in SLN biopsy is to identify the node drained directly from the tumor, it makes sense to inject the tracer into or closely around the tumor. Most authors initially favor peritumoral injection rather than intratumoral injection 1-3), because there is a potential danger of needle tract seeding by intratumoral injection. However, this appears to be associated with the technical problem of not being able to identify the SLN preoperatively or intraoperatively on a consistent basis because of significant "shine-through" from the peritumoral injection site, especially in the upper outer quadrant. Recently, several studies have been performed in which the blue dye or radioisotope tracer was injected either under or into the skin overlying the breast tumor 4' s), or subareolarly 6' 7). The lymphatics of the overlying skin may drain to the same SLN as the underlying glandular breast tissue 4>, and the lymphatic channels are much richer at the subcutaneous level than at the peritumoral site. Moreover, the subareolar lymphatic plexus communicates with superficial intramammary lymphatics 8) and the primary drainage of the breast may be more important in determining the SLN than the primary
収録刊行物
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- Breast Cancer
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Breast Cancer 9 91-94, 2002-04-01
Springer Science and Business Media LLC