CT/MR-guided sentinel lymph node mapping of breast cancer

三维多层螺旋CT淋巴造影在乳腺前哨淋巴结（SLN）活检中，使用组织间注射广泛可用的非离子型单倍造影剂碘帕醇（3D MDCT-LG）进行导航。在乳晕周围和瘤周区域按摩总共4-5 ml未稀释碘帕醇的连续68例早期乳腺癌患者的连续注射部位后，获得3D MDCT-LG。分期乳腺癌，使用四排探测器CT扫描仪。在3D MDCT-LG图像上评估引流淋巴模式和前哨淋巴结解剖结构。3D MDCT-LG-Navigated SLN活检联合使用蓝色染料，然后进行腋窝淋巴结清扫，以评估SLN活检的准确性。3D MDCT-LG图像通过观察所有患者周围结构的详细解剖结构上这些淋巴结与其输入淋巴管之间的直接连接，清晰地定位原发SLN。引流淋巴管可分为单径路/单个SLN（39例，57%）、多径路/多个SLN（10例，15%）、单径路/多个SLN（9例，13%）和多径路/单个SLN（10例，15%）。在3D MDCT-LG导航下，所有患者均在准确位置找到SLN。腋窝淋巴结清扫后，14例（20%）患者发现转移，其中8例仅在术前确定的SLN中发生转移。另外5例阳性患者，SLN和非SLN均发现转移。然而，微转移最终发现只有在非SLN的老年患者。总体而言，3D CT-L-导航SLN活检的敏感性、假阴性率和准确性分别为92%（13/14）、7%（1/14）和98%（67/68），拓扑3D间质MDCT-LG可作为乳腺SLN活检的广泛可用和可靠的导航器。

Three-dimensional multidetector-row computed tomographic lymphography (3D MDCT-LG) with interstitial injection of a widely-available nonionic monometric contrast medium iopamidol was used for navigation of breast sentinel lymph node (SLN) biopsy.3D MDCT-LG was obtained after massage of the interstitially injection sites of a total of 4-5 ml undiluted iopamidol at periareolar and peritumoral areas in 68 consecutive patients with early-stage breast cancer, using a four detector-row CT scanner. Drainage lymphatic patterns and SLN anatomy were assessed on 3D MDCT-LG images. 3D MDCT-LG-navigated SLN biopsy with combined use of blue dye was followed by backup axillary lymph node dissection to evaluate accuracy of SLN biopsy.The 3D MDCT-LG images clearly localized primary SLNs by visualizing the direct connection between these nodes and their afferent lymphatic vessels on detailed anatomy of the surrounding structures in all patients. Drainage lymphatic pathways on these images was classified into four patterns : single route/single SLN (39 cases, 57%), multiple routes/multiple SLNs (10 cases, 15%), single route/multiple SLNs (9 cases, 13%) and multiple routes/single SLN (10 cases, 15%). Under 3D MDCT-LG navigation, SLNs was found at the accurate location in all patients. With backup axillary lymph node dissection, metastasis was found in 14 (20%) patients, and 8 of these patients had metastasis only in the preoperatively identified SLNs. In other 5 positive patients, metastasis was found both in the SLN and non-SLNs. However, micrometastasis was eventually found only in non-SLN in an elderly patient. Overall, The sensitivity, false negative rate and accuracy of 3D CT -L-navigated SLN biopsy were 92% (13/14), 7% (1/14), and 98% (67/68), respectively.Topographic 3D interstitial MDCT-LG can be a widely-available and reliable navigator for breast SLN biopsy.