Tangoku Akira, Yamamoto Shigeru, Suga Kazuyoshi, Ueda Katsuhiko, Nagashima Yukiko, Hida Makoto, Sato Tomomitsu, Sakamoto Kazuhiko, Oka Masaaki
Departments of Surgery II, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Surgery. 2004 Mar;135(3):258-65. doi: 10.1016/j.surg.2003.07.003.
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.
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.
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.
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.
前哨淋巴结活检（SLNB）技术已应用于乳腺癌治疗。目前使用蓝色染料或放射性示踪剂标记前哨淋巴结的技术需要一个学习过程。对于示踪剂和注射部位的选择以及术中病理检查已有相关讨论。
我们利用市售的碘帕醇开发了一种三维计算机断层扫描淋巴造影（3D CT-LG）技术。对40例T1和T2期乳腺癌患者进行了前哨淋巴结活检及补救性清扫术。对CT-LG的可行性和有效性进行了检查。
在所有患者中，通过3D CT-LG均可观察到淋巴引流及周围解剖环境。由于3D CT-LG的精确导航，前哨淋巴结活检均获成功。所有患者均检测到前哨淋巴结，而在7例腋窝脂肪较多的患者及2例曾接受过切除活检的患者中，染料导航失败。补救性清扫术证实了CT-LG引导下前哨淋巴结活检的准确性。仅1例患者出现假阴性结果。在前哨淋巴结转移的病例中，术前预测是可行的。
CT-LG能够通过快速、充分地显示前哨淋巴结与其输入淋巴管之间的直接连接，实现前哨淋巴结的准确定位。CT扫描过程中详细的淋巴解剖横断面图像使得前哨淋巴结活检成功，并缩短了术前检查时间。
