Suga Kazuyoshi, Yuan Yue, Okada Munemasa, Matsunaga Naofumi, Tangoku Akira, Yamamoto Shigeru, Oka Masaaki
Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Radiology. 2004 Feb;230(2):543-52. doi: 10.1148/radiol.2302021380. Epub 2003 Dec 29.
To evaluate sentinel lymph node (SLN) mapping with interstitial computed tomographic (CT) lymphography with small volumes of iopamidol for direction of SLN biopsy in breast cancer.
Thin-section transverse and three-dimensional CT images that included the breast and axilla were acquired at multi-detector row helical CT in 17 patients with operable breast cancer before subcutaneous injection of 2 mL of undiluted iopamidol into peritumoral and periareolar areas and 1-5 minutes after massage of injection sites. Location and size of SLNs were assessed at CT lymphography and were compared with SLNs at standard axillary lymph node dissection with blue dye staining.
CT lymphography allowed localization of SLNs in all patients by means of visualization of a direct connection between an SLN and its afferent lymphatic vessels draining from the injection sites. Afferent vessels were joined and drained into a single axillary SLN, except in four patients with two or three SLNs, including a parasternal one. SLNs did not enhance because of rerouting of lymph flow in four patients. At surgery, SLNs that were stained or not stained with blue dye were easily found with CT lymphographic guidance. Tumoral infiltration was not evident in any resected nodes, except for infiltration in one patient with micrometastasis in SLN alone and infiltration in four patients with massive metastasis in both SLN and distant nodes.
Because preoperative CT lymphography-guided SLN mapping provides SLN position with detailed lymphatic anatomy, it may be useful for the direction of breast SLN biopsy.
评估采用小剂量碘帕醇进行间质计算机断层扫描（CT）淋巴造影术对前哨淋巴结（SLN）进行定位，以指导乳腺癌前哨淋巴结活检。
对17例可手术乳腺癌患者，在多排螺旋CT上获取包括乳房和腋窝的薄层横断面及三维CT图像。在瘤周和乳晕周围区域皮下注射2 mL未稀释的碘帕醇之前以及注射部位按摩1 - 5分钟后进行扫描。在CT淋巴造影时评估前哨淋巴结的位置和大小，并与标准腋窝淋巴结清扫术中用蓝色染料染色的前哨淋巴结进行比较。
通过CT淋巴造影能够观察到前哨淋巴结与其从注射部位引流的输入淋巴管之间的直接连接，从而在所有患者中实现前哨淋巴结的定位。除4例有两个或三个前哨淋巴结（包括一个胸骨旁前哨淋巴结）的患者外，输入淋巴管汇合后引流至单个腋窝前哨淋巴结。4例患者因淋巴引流改道，前哨淋巴结未强化。手术时，在CT淋巴造影引导下，容易找到经或未经蓝色染料染色的前哨淋巴结。除1例仅前哨淋巴结有微转移的患者以及4例前哨淋巴结和远处淋巴结均有大量转移的患者外，在任何切除的淋巴结中均未发现肿瘤浸润。
由于术前CT淋巴造影引导的前哨淋巴结定位可提供前哨淋巴结位置及详细的淋巴解剖结构，因此可能有助于指导乳腺癌前哨淋巴结活检。
