Kazuyoshi Suga MD, Presenter: Nothing to Disclose

Shigeru Yamamoto MD, Abstract Co-Author: Nothing to Disclose

Yasuhiko Kawakamii, Abstract Co-Author: Nothing to Disclose

Naofumii Matunaga MD, Abstract Co-Author: Nothing to Disclose

Computed tomographic lymphography (CTLG) with interstitial injection of iopamidol was developed for breast sentinel lymph node (SLN) mapping and biopsy.

CTLG was obtained after short massage of the interstitially injection sites of a total of 4-5 ml undiluted iopamidol at periareolar and peritumoral areas in 122 patients with early-stage breast cancer, using a multidetector-row CT unit. Under CTLG-guidance, 68 initial consecutive patients underwent SLN biopsy with a combined use of blue dye, followed by backup axillary lymph node dissection (ALND) to evaluate accuracy of SLN biopsy.

CTLG could visualize the direct connection between SLNs and their afferent lymphatic vessels in all patients; where, the drainage lymphatic routes were classified into 4 patterns: single route/single SLN (57%), multiple routes/multiple SLNs (17%), single route/multiple SLNs (15%) and multiple routes/single SLN (10%). Preoperative comprehensive anatomy of the drainage lymphatic routes on CTLG allowed to identify the blue lymphatic vessels and SLNs at accurate location during surgery in all 68 initial consecutive patients operated with backup ALND. With backup ALND, metastasis was found in 15 (22%) patients, and 9 cases had metastasis only in the preoperatively identified SLNs. In other 5 positive patients, metastasis was found both in the SLN and non-SLNs. However, metastasis was eventually found only in non-SLNs in one patient. The sensitivity, false negative rate and accuracy of SLN biopsy were 94% (12/13), 6% (1/16) and 99% (67/68), respectively. CTLG in the patients after breast conserving surgery showed the main stream of lymphatic routes at the same location as in preoperative CTLG, although the drainage lymph nodes were changed.

Interstitial CTLG is feasible for delineation of the main stream of breast lymphatic routes in patients with operable breast cancer and for accurate SLN mapping and biopsy.

Interstitial CTLG is feasible for accurate breast SLN mapping and biopsy.

Suga, K, Yamamoto, S, Kawakamii, Y, Matunaga, N, Interstitial CT Lymphography for Breast Sentinel Lymph Node Mapping and Biopsy.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4442150.html