[Selective sentinel node biopsy in breast cancer with contralateral axillary drainage].

We present the case of a 63-year-old woman diagnosed with infiltrating ductal carcinoma of the left breast (G1) in 1993 who underwent surgical treatment (tumorectomy and incomplete lymphadenectomy in which only 3 negative lymph nodes were obtained) and adjuvant chemo-radiotherapy (6 cycles of CMF and 50Gy to the breast, the axillary and supraclavicular lymph node chains with overdosage in the affected quadrant). Posterior checkups were normal until 2012 when recurrence was detected in a nodule of 2 cm located at the scar of the tumorectomy (G2, positive RH, negative Her2, and Ki 20%). After ruling out regional and distant involvement by imaging techniques (ultrasonography, thoraco-abdominal-pelvic CT and bone scintigraphy) the patient was referred toNuclearMedicine for selective sentinel node biopsy (SSNB). Anterior and left lateral images were obtained at 40 and 60min after the periareolar injection in the left breast of 111 MBq 99mTc-albumin nanocolloid. No radiotracer migration was observed (Fig. 1). In the absence of lymphatic drainage a SPECT-CT was performed showing uptake in 2 adjacent lymph nodes located in the contralateral axilla (right), corresponding to 2 sentinel lymph nodes at Berg level 1 (Fig. 2). At 24hpost-injection, leftmastectomywas carriedout. Previous to resection, the right axillary sentinel lymph nodes were localized using a gamma detector probe. Histological result was negative for metastasis in the 2 lymph nodes resected.