Sentinel lymph node mapping in ectopic breast cancer: A case report evaluating the efficacy of peri-areolar versus peri-tumoral injection techniques

Document Type : Case Report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

We present a rare case of primary breast cancer occurring within accessory breast tissue located in the left axillary region who was referred to our department for sentinel lymph node (SLN) mapping. Initial   peri-tumoral injection of the radiotracer didn’t show any axillary SLN. However, when the tracer was re-injection in the peri-areolar region of the normal (eutopic) breast, it successfully identified axillary sentinel node which was most clearly seen best on SPECT/CT images. This case underscores the feasibility of sentinel node mapping in cancer of ectopic breast tissue, highlighting that injection in the peri-areolar region of the eutopic breast appears to be a more effective technique.

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  1. Kayahan M, Koksal N, Gunes P, Uzun MA, Aliustaoglu M, Gunerhan Y, Bugan U. Ectopic breast carcinoma. J Coll Physicians Surg Pak. 2009 Nov;19(11):734-6. 
  2. Youn HJ, Jung SH. Accessory breast carcinoma. Breast Care (Basel). 2009;4(2):104-6. 
  3. Salemis NS. Primary ectopic breast carcinoma in the axilla: a rare presentation and review of the literature. Breast Dis. 2021;40(2):109-14. 
  4. Patel BK, Jafarian N, Abbott AM, Khazai L, Lee MC. Imaging findings and management of primary breast cancer in accessory axillary breast tissue. Clin Breast Cancer. 2015 Aug;15(4):e223-9. 
  5. Visconti G, Eltahir Y, Van Ginkel RJ, Bart J, Werker PM. Approach and management of primary ectopic breast carcinoma in the axilla: where are we? A comprehensive historical literature review. J Plast Reconstr Aesthet Surg. 2011 Jan;64(1):e1-11.
  6. Thasanabanchong P, Vongsaisuwon M. Unexpected presentation of accessory breast cancer presenting as a subcutaneous mass at costal ridge: a case report. J Med Case Rep. 2020 Mar 31;14(1):45.
  7. Lim HS, Kim SJ, Baek JM, Kim JW, Shin SS, Seon HJ, Heo SH. Sonographic findings of accessory breast tissue in axilla and related diseases. J Ultrasound Med. 2017 Jul;36(7):1469-78. 
  8. van Herwaarden-Lindeboom MY, van Hillegersberg R, van Diest PJ. Ectopic lobular breast cancer on the anterior chest wall: a rare entity. J Clin Pathol. 2007 Aug;60(8):940-1.
  9. Nguyen TH, El-Helou E, Pop CF, Shall A, Zaiter M, Naccour J, Ho XD, Nguyen TTH, Nguyen TMC, Bui TT, Nguyen VC, Hoang H. Primary invasive ductal carcinoma of axillary accessory breast. Int J Surg Case Rep. 2022 Sep;98:107597.
  10. Giammarile F, Vidal-Sicart S, Paez D, Pellet O, Enrique EL, Mikhail-Lette M, Morozova O, Maria Camila NM, Diana Ivonne RS, Delgado Bolton RC, Valdés Olmos RA, Mariani G. Sentinel lymph node methods in breast cancer. Semin Nucl Med. 2022 Sep;52(5):551-60. 
  11. Harris MK, Guo MZ, Mangino A, Taylor C, Carson WE. Sentinel node mapping and biopsy in ectopic axillary breast cancer: a case report and review of the literature. Clin Case Rep. 2022 Sep 5;10(9):e6052. 
  12. Sadeghi R, Asadi M, Treglia G, Zakavi SR, Fattahi A, Krag DN. Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2014 Apr;144(2):213-22.
  13. Lee J, Jung JH, Kim WW, Hwang SO, Kang JG, Baek J, Kim HJ, Park JY, Jeong JY, Lim JY, Park HY. Ductal carcinoma arising from ectopic breast tissue following microcalcification observed on screening mammography: a case report and review of the literature. J Breast Cancer. 2014 Dec;17(4):393-6.
  14. Nardello SM, Kulkarni N, Aggon A, Boraas M, Sigurdson ER, Bleicher RJ. Invasive mucinous carcinoma arising in ectopic axillary breast tissue: a case report and literature review. Am J Case Rep. 2015 Mar 14;16:153-9.
  15. Shuster M, Tse JY, Smith GP. Breast carcinoma arising in ectopic breast tissue presenting as an enlarging axillary nodule. Indian J Dermatol Venereol Leprol. 2015 Jul-Aug;81(4):422-4. 
  16. Jalali U, Dhebri A, Karip E, Hunt R. Ectopic breast carcinoma presenting as sebaceous cyst left axilla. BMJ Case Rep. 2019 Jan 24;12(1):e224789.
  17. Tsuji W. Metachronous bilateral ectopic breast carcinoma in the axilla: a case report and literature review. Breast Dis. 2020;39(3-4):149-53. 
  18. Addae JK, Genuit T, Colletta J, Schilling K. Case of second primary breast cancer in ectopic breast tissue and review of the literature. BMJ Case Rep. 2021 Apr 8;14(4):e241361. 
  19. Achouri L, Jellali A, Henchiri H, Boukhris S, Zaaimi Y, Mansouri H, Mahjoub N. Primary ectopic breast carcinoma: a case report. J Med Case Rep. 2022 Nov 26;16(1):443. 
  20. Alavifard R, Kadkhodayan S, Homaee Shandiz F, Dabbagh VR, Sadeghi R. Is sentinel node mapping possible in surgically removed ectopic axillary breast cancer? A case report. Nucl Med Rev Cent East Eur. 2016;19(B):29-30.
  21. Tanis PJ, Nieweg OE, Valdés Olmos RA, Kroon BB. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg. 2001 Mar;192(3):399-409.
  22. Borgstein PJ, Meijer S, Pijpers RJ, van Diest PJ. Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg. 2000 Jul;232(1):81-9.
  23. Rodier JF, Velten M, Wilt M, Martel P, Ferron G, Vaini-Elies V, Mignotte H, Brémond A, Classe JM, Dravet F, Routiot T, de Lara CT, Avril A, Lorimier G, Fondrinier E, Houvenaeghel G, Avigdor S. Prospective multicentric randomized study comparing periareolar and peritumoral injection of radiotracer and blue dye for the detection of sentinel lymph node in breast sparing procedures: FRANSENODE trial. J Clin Oncol. 2007 Aug 20;25(24):3664-9.
  24. Caruso G, Cipolla C, Costa R, Morabito A, Latteri S, Fricano S, Salerno S, Latteri MA. Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients. Acta Radiol. 2014 Feb;55(1):39-44.
  25. Eroglu A, Mudun A, Berberoglu K, Asoglu O, Ozmen V, Muslumanoglu M, Bozfakioglu Y, Yavuz E, Tuzlali S, Cantez S. Comparison of subdermal and peritumoral injection techniques of lymphoscintigraphy to determine the sentinel lymph node in breast cancer. Clin Nucl Med. 2004 May;29(5):306-11.