Breast sentinel lymph node mapping at CT lymphography with iopamidol: preliminary experience.
OBJECTIVE
To evaluate sentinel lymph node (SLN) mapping with interstitial computed tomographic (CT) lymphography with small volumes of iopamidol for direction of SLN biopsy in breast cancer.


METHODS
Thin-section transverse and three-dimensional CT images that included the breast and axilla were acquired at multi-detector row helical CT in 17 patients with operable breast cancer before subcutaneous injection of 2 mL of undiluted iopamidol into peritumoral and periareolar areas and 1-5 minutes after massage of injection sites. Location and size of SLNs were assessed at CT lymphography and were compared with SLNs at standard axillary lymph node dissection with blue dye staining.


RESULTS
CT lymphography allowed localization of SLNs in all patients by means of visualization of a direct connection between an SLN and its afferent lymphatic vessels draining from the injection sites. Afferent vessels were joined and drained into a single axillary SLN, except in four patients with two or three SLNs, including a parasternal one. SLNs did not enhance because of rerouting of lymph flow in four patients. At surgery, SLNs that were stained or not stained with blue dye were easily found with CT lymphographic guidance. Tumoral infiltration was not evident in any resected nodes, except for infiltration in one patient with micrometastasis in SLN alone and infiltration in four patients with massive metastasis in both SLN and distant nodes.


CONCLUSIONS
Because preoperative CT lymphography-guided SLN mapping provides SLN position with detailed lymphatic anatomy, it may be useful for the direction of breast SLN biopsy.
Suga
Kazuyoshi
K
Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan. sugar@po.cc.yamaguchi-u.ac.jp
Yuan
Yue
Y
Okada
Munemasa
M
Matsunaga
Naofumi
N
Tangoku
Akira
A
Yamamoto
Shigeru
S
Oka
Masaaki
M
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007479:Iopamidol; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008220:Lymphography; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D025321:Surgery, Computer-Assisted; D036542:Tomography, Spiral Computed
D003287:Contrast Media; D007479:Iopamidol