Minato Masako, Hirose Chieko, Sasa Mitsunori, Nishitani Hiromu, Hirose Yukiko, Morimoto Tadaoki
Department of Radiology, National Higashi-Tokushima Hospital, 1-1 Ohmukai-kita, Ootera, Itano, Tokushima 779-0193, Japan.
J Comput Assist Tomogr. 2004 Jan-Feb;28(1):46-51. doi: 10.1097/00004728-200401000-00007.
Simple and reliable identification methods for sentinel lymph nodes (SLNs) which do not use radioisotope are essential for early breast cancer patients in community hospitals in Japan. The purpose of this paper is to demonstrate the feasibility and efficacy of computed tomography (CT) lymphography for SLN detection.
The study included 15 cases with T1 or T2 breast cancer. After subcutaneous injection of 1 mL of iopamidol in 1 subareolar area of the affected breast, CT scanning was carried out and 3-dimensional (3D) CT images were created. SLNs predicted from images and CT values were assessed as to whether they were identical to those identified by the dye method.
An enhanced lymph vessel draining into SLN was demonstrated in 11 cases (73%) and an enhanced SLN in 10 cases (67%). 3D images clearly revealed the anatomic relationship between lymph vessels, SLN, and the surrounding structures. In addition, SLN could be predicted by the change of CT value in the time-course in another case. In total, SLN in 13 cases (87%) could be predicted. All SLNs suggested from CT lymphography were identified by the dye method. No significant adverse effect was noted in any case.
The present clinical trial indicated that subcutaneous injection of nonionic contrast medium with CT scanning seems to be a promising method for the demonstration of a draining lymph vessel and SLN. The CT value time-course may also provide some important information. Further trials will be needed for the successful establishment of this CT lymphography-guided method for SLN identification.
对于日本社区医院的早期乳腺癌患者而言，不使用放射性同位素的简单可靠的前哨淋巴结（SLN）识别方法至关重要。本文旨在证明计算机断层扫描（CT）淋巴造影术用于检测SLN的可行性和有效性。
该研究纳入了15例T1或T2期乳腺癌患者。在患侧乳房的1个乳晕下区域皮下注射1 mL碘帕醇后，进行CT扫描并创建三维（3D）CT图像。根据图像和CT值预测的SLN与通过染料法识别的SLN是否一致进行评估。
11例（73%）显示有引流至SLN的强化淋巴管，10例（67%）显示有强化的SLN。3D图像清晰显示了淋巴管、SLN与周围结构之间的解剖关系。此外，在另一例中可通过CT值随时间变化来预测SLN。总共可预测13例（87%）的SLN。CT淋巴造影提示的所有SLN均通过染料法得以识别。所有病例均未观察到明显不良反应。
目前的临床试验表明，皮下注射非离子型造影剂并进行CT扫描似乎是一种显示引流淋巴管和SLN的有前景的方法。CT值随时间变化过程也可能提供一些重要信息。要成功建立这种CT淋巴造影引导的SLN识别方法，还需要进一步试验。
