Subareolar Injection May Not Always Identify the Same Sentinel Lymph Nodes as Peritumoral Injection in Breast Cancer, pp. 177-188
Authors: Masakuni Noguchi, Department of Breast Oncology, Kanazawa University Hospital, Kanazawa, Japan
Abstract: Over the past decade, the surgical management of early breast cancer has changed from total mastectomy to breast-conserving treatment and from routine axillary lymph node dissection to sentinel lymph node (SLN) biopsy. Currently, SLN biopsy has become a highly utilised and widely accepted method for surgical staging of axillary lymph nodes in breast cancer surgery in Japan as well as in the western countries. In Japan, the number of breast cancer patients treated with SLN biopsy is recently increasing. According to the results of questionnaire survey on breast caner surgery, SLN biopsy was done in 91.5% of institutions and 56% of patients in 2006 . Because SLN technology has been evolving rapidly, nevertheless, variations in techniques have been widespread, and anecdotal evidence rather than controlled observation has been the rule. No standard procedure has been established yet in either Japan or Western countries. There many questions remain regarding SLN biopsy, especially those concerning the prevention of false-negative biopsies and improvement of the yield of successful visualisation and localisation procedures. One such controversy involves the injection site of mapping tracer with different authors advocating peritumoral, intradermal, subdermal, subareolar and periareolar tracer injection. It remains unclear whether the subdermal, subareolar and peritumoral lymphatics of the breast always drain into the same nodes and which route best simulates the spread of breast cancer [2,3,4]. It is of course important to identify “true” SLNs as well as to improve the identification rate of SLNs.