BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Ali R Sever; Philippa Mills; Jean-Marc Hyvelin; Jennifer Weeks; Hatice Gumus; David Fish; Willem Mali; Susan E Jones; Peter A Jones; Haresh Devalia Journal: Eur Radiol Date: 2011-10-07 Impact factor: 5.315