Sentinel lymph node biopsy using computed tomography-lymphography in patients with breast cancer
Sentinel lymph node biopsy using computed tomography-lymphography in patients with breast cancer
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DOI：
10.1016/j.surg.2003.07.003
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发表时间：
2004-03-01
期刊：
影响因子：
3.8
通讯作者：
Oka, M
中科院分区：
文献类型：
--
作者：
Tangoku, A;Yamamoto, S;Oka, M
背景资料。前哨淋巴结活检(SLNB)技术是在乳腺癌的治疗中建立起来的。目前用蓝色染料或放射性示踪剂绘制SLN图谱的技术需要学习一段时间。对示踪剂和注射部位的选择及术中病理检查进行了讨论。我们开发了一种三维计算机断层扫描淋巴造影(3DCT-LG)技术，该技术可用于商业用途的异丙咪醇。对40例T1、T2乳腺癌患者行SLNB及后备解剖。分析CT-LG检查的可行性和有效性。所有患者均行三维CT-LG扫描，显示淋巴流动及周围解剖环境。SLNB的成功得益于3D CT-LG的准确导航。所有患者都检测到了SLN，而7名脂肪腋下和2名既往切除活检的患者染料导航失败。后备解剖证实了CT-LG引导下SLNB的准确性。只有一名患者出现假阴性结果。对于SLN转移病例，术前预测是可行的。CT-LG通过快速和充分地显示SLN与其传入淋巴管之间的直接联系，实现了SLN的准确定位。CT过程中淋巴解剖的详细横断面图像导致SLNB成功，并缩短了术前检查计划。
Background. The sentinel lymph node biopsy (SLNB) technique is established in the treatment of breast cancer. The current technique of mapping the SLN with blue dye or radiotracers requires a learning period. Tracer and injection site selection and intraoperative pathologic examination have been discussed.Methods. We developed a three-dimensional computed tomography lymphography (3D CT-LG) technique with commercially available iopamidol. SLNB and backup dissection were performed in 40 patients with T1 and T2 breast cancer. Feasibility and efficacy of CT-LG were examined.Results. In all patients, lymph flow and the surrounding anatomical environment were visualized with 3D CT-LG. SLNB was successful because of accurate navigation by 3D CT-LG. SLN was detected in all patients, whereas dye navigation failed in seven fatty axilla and two patients with prior excisional biopsy. Backup dissection confirmed the accuracy of CT-LG-guided SLNB. A false negative result was found in only one patient. Preoperative prediction was feasible in cases of SLN metastasis.Conclusions. CT-LG allowed accurate SLN localization by quickly and adequately visualizing the direct connection between the SLN and its afferent lymphatic vessels. Detailed cross-sectional images of lymphatic anatomy during CT resulted in successful SLNB with shortening of the presurgical examination schedule.