Bilateral axillary and internal mammary drainage in breast cancer without prior surgery during sentinel node mapping
A 48-years-old woman with no prior surgery of breast or axilla was diagnosed of breast ductal carcinoma in retroareolar region of the right breast with size of 2 cm. Axillary manual exploration and ultrasound were negative. Lumpectomy and sentinel lymphatic node (SLN) biopsy was suggested.\nThe day prior to surgery, a lymphoscintigraphy was performed with peritumoral injection of two doses of 74 MBq of Technetium-99m-nanocolloid (volume of 0.1 ml) each one. Planar images were acquired at 120 min of injection, including chest in anterior and lateral projections. We acquired images of 3 min in a 256 × 256 matrix using a planar source of Cobalt-57 in anterior projection and an anatomical point source of Tc99m in order to delineate the body shape and locate the nodes. The images showed drainage to ipsilateral axillary nodes, ipsilateral IMC and contralateral axillary nodes [].\nIn the operating room, lumpectomy and SLN biopsy of the three territories were performed. Frozen section and subsequent 2 mm step sections of the paraffin embedded nodes did not reveal metastases in any of the lymph nodes. Surgical wound was closed and regional lymphadenectomy was not performed. Delayed studies with inmunohistochemical techniques were also negative in all nodes. The patient was treated with chemotherapy, radiotherapy and hormone therapy and no significant complications were observed. Two years and 6 months after surgery the patient remains free of disease.