Demonstration of tissue alterations by ultrasonography, magnetic resonance imaging and spectroscopy, and histology in breast cancer patients without lymphedema after axillary node dissection.

Estimates of the incidence of arm swelling after axillary lymph node dissection for breast cancer range from 10 to 37%. Yet the subjective sensation of edema is described in at least 54% of patients. The purpose of this research was to examine the structural changes occurring in the subcutaneous tissue that might explain these subjective complaints using multiple imaging modalities. Two female cadavers with unilateral breast amputation and axillary dissection were studied. The dermal and subcutaneous layers of both arms were visualized with high frequency ultrasonography, and magnetic resonance imaging and spectroscopy (MRS), and tissue biopsies were taken for histological evaluation. On the operated side, ultrasound imaging showed a hyperechogenic subcutis and the fat-to-water relationship in adipose cells was higher as measured by MRS. Dissection of the arms revealed structural adipose tissue changes, which were confirmed by microscopic evaluation.

Drainage pattern of the upper medial quadrant of the breast in young healthy women after subdermal injection: a lymphscintigraphic study.

This study examines the lymphatic drainage after injection of a radiotracer in the upper medial quadrant of the right breast in young healthy female subjects. Most studies concerning lymphatic drainage pathways have focused on the upper lateral quadrant of the breast because of the high incidence of carcinoma in this quadrant while the drainage pattern of the medial quadrant has been less studied. We injected radiotracer (Human Serum Albumin labeled with 99 technetium) subdermally into the upper medial quadrant of the right breast tissue of 33 young healthy female volunteers and obtained static images with a scintillation camera briefly after injection and approximately one hour after injection. We identified lymphatic pathways in 82.8% of our subjects, lymph nodes in 79.3% and in 3.4%, a sentinel lymph node was found in the internal mammary chain. In early images, lymph nodes were visualized in 65.5% of subjects while in 17.2% of subjects, lymphatic vessels only appeared on later images.

Lymphatic pathways of the upper medial quadrant of the breast in healthy women: radiotracer study of the sentinel lymph node.

This study examined the lymphatic drainage after injection of a radiotracer into the upper medial quadrant of the breast in healthy women. Most studies of lymphatic pathways of the breast have been performed in patients with breast cancer and concentrate on the upper lateral quadrant of the breast because of the high incidence of carcinoma at this site. The lymphatic drainage pathways of the medial half of the breast, however, has been less studied. A radiotracer (Tc-99m human serum albumin nanocolloid or HSA) was injected intradermally into the upper medial quadrant of the right breast in 12 healthy women. Dermal markers were placed at the middle of the clavicle, the axilla and at the jugular incisura. Three minutes after injection a static image of the injection site was made with a scintillation camera (Multispect 2 Gamma Camera System) over 20 seconds. After nine minutes, local soft massage was instituted at the injection site for 6 minutes. Fifteen minutes after injection, a graphic scintigraphic image was made of both breasts and axillae over 22 minutes. After this interval, three or four static images were made for a few seconds to locate the sentinel lymph node as related to the injection site. A sentinel lymph node (lymphatic pathway) in the axilla was visualized in 11 subjects (91.9%) and was undetected in one subject (8.3%). The radiotracer migrated in all patients (100% ) towards the ipsilateral axilla. In 9 subjects, the sentinel lymph node was visualized 15 minutes after injection, whereas in 2 subjects it appeared within an hour.