Lymphoscintigraphy of a Breast Tumor Showing Focal Tracer Accumulation Along the Falciform Ligament of the Liver

Abstract

99mTechneti um-nanocolloid was injected intratumorally in a pati ent with a left breast carcinoma. Sequenti al planar images showed drainage to an axillary and a left parasternal senti nel node. The liver showed faint homogeneous tracer uptake but there was also focal tracer accumulati on adjacent to the liver. SPECT/CT visualized the two senti nel nodes, but also intense tracer accumulati on along the falciform ligament. Lymph from the breast can follow unpredictable pathways and may travel retrograde via the internal mammary chain towards lymphati c channels along the falciform ligament. This phenomenon might also explain incidental observati ons of umbilical metastasis in breast cancer. Lymphati c mapping was performed in a 50-year old woman with a non-palpable cT2N0 carcinoma of the left breast. One deposit of 0.2ml of 138 MBq (3.7 mCi) 99mTechneti umnanocolloid was injected into the tumor guided by ultrasonography. Anterior and lateral sequenti al planar images were performed aft er fi ft een minutes, two hours and four hours (A). No axillary drainage was visualized at fi ft een minutes, although generalized faint liver uptake was present, as well as two spots of focal tracer accumulati on within the contour of the liver on the anterior image. Aft er two and four hours, this parti cular distributi on of the radio-colloid in the upper abdomen was sti ll present. Furthermore, an intense axillary senti nel node and weak left parasternal node were visualized (A).