A case report of invasive ductal adenocarcinoma identified in a lymphatic channel: a staging controversy.

A 65-year-old woman underwent core biopsy of a palpable left breast mass. This was a Nottingham grade II invasive ductal carcinoma with lymphovascular invasion. The tumor was ER/PR positive and Her-2/neu negative. The patient agreed to participate in the American College of Surgeon’s Oncology Group Z00100 trial. Two weeks later, the patient underwent a left breast lumpectomy, sentinel lymph node (SLN) biopsy, and bone marrow biopsy. Lymphatic mapping and SLN biopsy were performed utilizing a combination mapping agent technique. Manual intermittent breast massage was performed for 5 minutes after injection of the mapping agents. A single SLN was identified that was both blue and “hot.”