Abstract
BackgroundThe exact lymphatic drainage pattern of the breast hasn't been explained clearly. The aim of this study was to investigate the sentinel lymphatic channels (SLCs) in the cancerous breast. Whether the type of SLCs influenced the detection rate and false-negative rate of SLNB was also assessed.Methodology and Principal FindingsMimic SLNB was performed in 110 early-stage breast cancer patients with subareolar injection of blue methylene dye intraoperatively. Postoperatively, 110 specimens of modified radical mastectomy were examined for all blue SLCs after additional injection of methylene dye in peritumoral parenchyma. Interestingly, three types of SLCs, including superficial sentinel lymphatic channel (SSLC), deep sentinel lymphatic channel (DSLC), and penetrating sentinel lymphatic channel (PSLC) were found in 107 patients. Six lymphatic drainage patterns based on the three types of SLCs were observed in these 107 patients. The proportions of the drainage pattern SSLC, DSLC, PSLC, SSLC+DSLC, SSLC+PSLC, and DSLC+PSLC in the breast were 43%, 0.9%, 15.9%, 33.6%, 3.7% and 2.8%, respectively. The lymphatic drainage pattern in the breast was a significant risk factor for unsuccessful identification of sentinel lymph nodes (P <0.001) and false-negatives in SLNB (P = 0.034) with the subareolar injection technique.ConclusionsThree kinds of SLCs are the basis of six lymphatic drainage patterns from the breast to the axilla. The type of SLCs is the factor influencing the detection rate and false-negative rate of SLNB. These findings suggest the optimal injection technique of the combination of superficial and deep injection in SLNB procedures. Future clinical studies are needed to confirm our novel findings.
Highlights
Sentinel lymph nodes (SLNs) can accurately predict axillary lymph nodes status, which is an important prognostic factor in breast cancer [1] and determines the subsequent adjuvant treatment [2]
Three kinds of sentinel lymphatic channels (SLCs) are the basis of six lymphatic drainage patterns from the breast to the axilla
As a minimally invasive approach, sentinel lymph node biopsy (SLNB), which can reduce postoperative morbidity compared with axillary lymph node dissection (ALND) [3,4,5], has become a standard surgical technique in the management of early invasive breast cancer patients with clinically negative lymph nodes [6,7]
Summary
Sentinel lymph nodes (SLNs) can accurately predict axillary lymph nodes status, which is an important prognostic factor in breast cancer [1] and determines the subsequent adjuvant treatment [2]. In 1959 Turner-Warwick suggested that the importance of the subareolar plexus was overemphasized because Sappey had mistaken the mammary duct for a lymphatic vessel [8,13] He found that the breast drained directly from the tumor to the axilla, which we have named as the deep sentinel lymphatic channel (DSLC). The exact route of breast lymphatic drainage to the axilla continues to be debated, recently Suami et al provided more knowledge on the lymphatic anatomy of the breast [8] Like those of Sappey, Suami’s findings were based on the anatomy of the normal cancer-free breast in 14 adult cadavers. Whether the type of SLCs influenced the detection rate and false-negative rate of SLNB was assessed
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