Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma

In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.

Aberrant Lymphatic Drainage of Primary Invasive Lobular Carcinoma with Concurrent Primary Lung Adenocarcinoma: A Case Report

Background: Lymphatic spread of breast cancer is currently well understood and can be assessed in breast cancer patients through the use of lymphatic mapping with sentinel node biopsy, CT, PET. The Case: Here we present a case report of a 73-year-old female with two distinct primary carcinomas, right-sided invasive lobular carcinoma of the breast and left-sided adenocarcinoma of the lung. We also discuss the predictable and unpredictable lymphatic drainage of the lobular carcinoma, including ipsilateral drainage to the axillary chain and suspected contralateral hilar and mediastinal lymph node metastasis. Conclusion: The unique lymphatic spread of breast cancer, in this case, emphasizes the use of lymphatic mapping for the staging of disease and staining biopsied tissue samples for tumor markers to guide treatment. Additional anatomic research in this patient or supporting reported cases are needed to determine the frequency and cause of aberrant lymphatic drainage of primary invasive lobular carcinoma of the breast.