Subject(s)
Humans , Female , Middle Aged , False Positive Reactions , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy/trends , Lymph Nodes/radiation effects , Lymph Nodes , /methods , Neoplasms, Ductal, Lobular, and Medullary , Carcinoma, Ductal, Breast , Sensitivity and Specificity , Lymph Nodes/physiopathology , Lymph Nodes , Breast/pathology , Breast/ultrastructure , RadiopharmaceuticalsSubject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Lymphatic Metastasis/diagnostic imaging , Sentinel Lymph Node Biopsy , Axilla , Breast Neoplasms/complications , Breast Neoplasms/diagnostic imaging , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/diagnostic imaging , False Positive Reactions , Female , Fibrocystic Breast Disease/complications , Fibrocystic Breast Disease/diagnostic imaging , Fibrocystic Breast Disease/pathology , Humans , Lymph Node Excision , Mastectomy, Segmental , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Aggregated Albumin , UltrasonographyABSTRACT
The use of deep (intratumoral, peritumoral) and superficial (subdermal, subareolar) administration is recognized as valid in sentinel lymph node biopsy for breast cancer. Herein, we are presenting a clinical case in which a personalized methodology was a determining factor in axillary staging. Initially, the radiotracer was injected intratumorally guided by ultrasound. The ultrasound scan identified a previously unknown axillary lymphadenopathy, with focal cortical thickening, this being a non-specific ultrasound finding, but with possibility of biopsy. The lymphoscintigraphy did not show uptake in the mentioned node, hence, a second subareolar dose was administered. On this occasion, the lymphoscintigraphy detected drainage to the sentinel node, which was the only one positive for micrometastases.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Radiopharmaceuticals/administration & dosage , Sentinel Lymph Node Biopsy/methods , Technetium Tc 99m Aggregated Albumin/administration & dosage , Axilla , Female , Humans , Injections, Intralesional , Lymphatic Metastasis/diagnostic imaging , Middle Aged , Neoplasm Staging , Nipples , Radionuclide ImagingABSTRACT
The 131I scan is the preferred test in the follow-up of differentiated thyroid cancer patients although the many unusual circumstances of radioiodine uptake that can provide false positive results must be identified. We present the case of a woman who had undergone a thyroidectomy and was being treated for follicular carcinoma with an ablative dose os radioiodine whose pre- and post-treatment scans only revealed post-surgical residual thyroid tissues. A total body scan with 131I performed at one year demonstrated the success of the ablation. However, a left supra-orbital pathological deposit was observed during a subsequent routine 131I scan. The thyroglobulin serum level was below the sensitivity level for the assay (< 1 ng/ml) and the serum antibodies against thyroglobulin were not detected. A simple x-ray and bone scintigraphy were inconclusive. The CT and MRI revealed the presence of a mucocele in the left frontal sinus which was confirmed through histological examination. The possibility of a false positive results in an 131I scan must always be kept in mind, especially in the presence of atypical uptakes and undetectable thyroglobulin serum levels. As far as we know, only one similar case has been published previously.