Department of Surgery, Sapporo Medical Center NTT EC, Nishi 15, Minami 1, Chuo-ku, Sapporo, Hokkaido, 060-0061, Japan.
Surg Today. 2010 Nov;40(11):1023-6. doi: 10.1007/s00595-009-4185-4. Epub 2010 Nov 3.
Sentinel lymph node biopsy (SLNB) is widely used in the detection of breast cancer metastasis, and a retrospective study was conducted to determine whether the preoperative assessment of axillary lymph node metastasis using multidetector-row computed tomography (MDCT) images would contribute to the selection of patients who require SLNB.
Seventy of the 164 patients who underwent surgery of the breast during the period of April 2006 to December 2008 were selected as subjects who: (1) did not undergo preoperative chemotherapy; (2) had undergone MDCT before the surgery; (3) had undergone either SLNB or axillary lymph node removal during the operation; and (4) whose T factor was pathologically T2 or less. The diameter and shape of the largest lymph node that was identified on an MDCT image of the axilla on the affected side were measured and compared with permanent pathological specimens.
Size: The group with lymph node metastasis included 21 subjects with an average diameter of the largest lymph node of 10.3 mm (range, 6-23 mm), and the nonmetastasis group included 49 subjects with that of 7.1 mm (5-13 mm). Shape: Round lymph nodes that internally contained no fat concentration in 24 subjects, and cuneate or round lymph nodes that internally contained a fat concentration in 46 subjects. The observable lymph nodes that were round had a diameter of at least 10 mm, and internally contained no fat concentration (A) were regarded as positive, whereas the cuneate or round lymph nodes that measured less than 8 mm in diameter and internally contained fat concentration (B) were regarded as negative, and both positive predictive value and negative predictive value was 100%.
Axilla removal was performed from the beginning in the case of (A) by assessing the size and shape for the presence or absence of axillary lymph node metastasis before surgery using MDCT.
前哨淋巴结活检（SLNB）广泛用于乳腺癌转移的检测，本回顾性研究旨在确定术前使用多排螺旋 CT（MDCT）图像对腋窝淋巴结转移的评估是否有助于选择需要 SLNB 的患者。
选择 2006 年 4 月至 2008 年 12 月期间接受乳房手术的 164 例患者中的 70 例作为研究对象：（1）未行术前化疗；（2）手术前进行 MDCT 检查；（3）术中行 SLNB 或腋窝淋巴结清扫术；（4）T 分期病理为 T2 及以下。测量并比较患侧腋窝 MDCT 图像上最大淋巴结的直径和形状与永久病理标本。
大小：淋巴结转移组 21 例，最大淋巴结平均直径为 10.3mm（范围 6-23mm），无转移组 49 例，最大淋巴结直径为 7.1mm（范围 5-13mm）。形状：24 例圆形淋巴结内部无脂肪浓度，46 例楔形或圆形淋巴结内部含有脂肪浓度。可见直径至少 10mm、内部无脂肪浓度的圆形淋巴结（A）视为阳性，直径小于 8mm 且内部含有脂肪浓度的楔形或圆形淋巴结（B）视为阴性，阳性预测值和阴性预测值均为 100%。
术前通过 MDCT 评估腋窝淋巴结转移的大小和形态，对（A）患者直接行腋窝清扫术。
