138
Static Imaging
Static imaging confirmed the presence of at least
two areas of focal activity which were considered
to be the sentinel nodes.
Operative Findings
At operation 2 ml of patent blue dye was injected
at the tumour site. On exploration of the axilla
with the Neoprobe 1500, a hot node was found at
level 1. After excising the node, gamma detection
probe was re-applied and this revealed another
lymph node proximal to the first one; this second
node showed more radioactivity and had taken
up the blue dye as well. This was also biopsied
and the patient underwent wide local excision
and axillary node clearance.
A 50-year-old female presented with a lump in
her left breast. On examination there was a 2-cm
ill-defined mass in the upper inner quadrant of
the left breast. There was no evidence of axillary
lymphadenopathy. Investigations confirmed the
diagnosis of breast cancer.
Lymphoscintigraphy
Lymphoscintigraphy was performed after in-
jection of 15MBq of
99m
Tc-colloidal albumin.
During injection it was felt that it was adminis-
tered deeper than usual in the subcutaneous fat.
Dynamic acquisition and static acquisition did not
reveal any sentinel lymph node. Delayed imaging
18 h after injection also failed to show focal
uptake. As the patient’s operation had to be post-
poned, she underwent repeat imaging 2 days later.
Dynamic Imaging
case
10
Upper Inner Quadrant Breast Carcinoma
Repeat dynamic imaging revealed a rapid transit
of tracer through the lymphatic channels to the
first drainage basin, with visualisation of the
sentinel node.
Histology
Histology revealed a 2.5-cm, grade 3 invasive duc-
tal carcinoma with vascular permeation. Two sen-
tinel nodes were replaced with metastatic tumour.
An additional three lymph nodes from axillary
clearance contained metastases.
Teaching Point
This case demonstrates that the injection technique is an important variable in sentinel node local-
isation. It was felt that the first injection was delivered into the subcutaneous tissue and the tracer
did not move due to the poor lymphatic supply in this layer. Subsequent injection into the sub-
dermal lymphatic plexus was successful in demonstrating the sentinel nodes.
