Extremely indirect dermal lymphatic channels: value of areolar-cutaneous junction injection technique for breast lymphoscintigraphy.

This case describes a patient who initially had peri-excisional injections of radiocolloid around a lumpectomy site that failed to visualize sentinel nodes during lymphoscintigraphy. After additional areolar-cutaneous junction injections, extremely indirect dermal lymphatic pathways were evident with resultant drainage to two sentinel nodes, both of which contained disease. Hybrid combination injections of radiotracer during sentinel lymph node biopsy is gaining in popularity.

Areolar-cutaneous "junction" injections to augment sentinel node count activity.

Purpose: The authors report on a modified lymphoscintigraphy protocol for increasing activity in the sentinel node (SN) through a specific technique (LymphoBoost). It consists of an areolar-cutaneous "junction" injection, using a very shallow, high-volume, high-specific-activity injection of 100% filtered Tc-99m sulfur colloid, as an adjunct to their standard protocol.

Materials And Methods: Results from a previously optimized protocol (group 1, n = 28) were compared with those from their new protocol (group 2, n = 85), which consisted of two sets of consecutively applied (within 12 to 20 minutes) injections: group 2A composed of perilesional and intradermal injections (similar to the previous group 1) followed by group 2B LymphoBoost injections within 12 to 20 minutes in the same patients.