Abstract
To evaluate the anatomical classification and location of breast sentinel lymph nodes, preoperative computed tomography–lymphography examinations were retrospectively reviewed for sentinel lymph nodes in 464 cases clinically diagnosed with node-negative breast cancer between July 2007 and June 2016. Anatomical classification was performed based on the numbers of lymphatic routes and sentinel lymph nodes, the flow direction of lymphatic routes, and the location of sentinel lymph nodes. Of the 464 cases reviewed, anatomical classification could be performed in 434 (93.5 %). The largest number of cases showed single route/single sentinel lymph node (n = 296, 68.2 %), followed by multiple routes/multiple sentinel lymph nodes (n = 59, 13.6 %), single route/multiple sentinel lymph nodes (n = 53, 12.2 %), and multiple routes/single sentinel lymph node (n = 26, 6.0 %). Classification based on the flow direction of lymphatic routes showed that 429 cases (98.8 %) had outward flow on the superficial fascia toward axillary lymph nodes, whereas classification based on the height of sentinel lymph nodes showed that 323 cases (74.4 %) belonged to the upper pectoral group of axillary lymph nodes. There was wide variation in the number of lymphatic routes and their branching patterns and in the number, location, and direction of flow of sentinel lymph nodes. It is clinically very important to preoperatively understand the anatomical morphology of lymphatic routes and sentinel lymph nodes for optimal treatment of breast cancer, and computed tomography–lymphography is suitable for this purpose.
Highlights
A sentinel lymph node (SLN) is any lymph node that directly receives lymph drainage from a tumor site (Uren et al 2003). Uren et al (2003) reported that SLNs need not necessarily
The location and flow direction of SLNs have been studied in cadavers (Suami et al 2009a, b) and by the radioisotope method (Blumgart et al 2011a, b), but the anatomical morphology of lymphatic routes and SLNs using Computed tomography lymphography (CT-LG) has not been extensively studied since the report of Yamamoto et al (2016)
Based on the reports of Kutsuna (1968) and Kaneko (2001), SLNs were classified into three categories, based on flow direction: (a) flowing outward on the superficial fascia toward the axillary lymph nodes, (b) flowing upward on the superficial fascia toward the infraclavicular or supraclavicular nodes, and (c) flowing toward the midline and reaching the parasternal or contralateral axillary lymph nodes
Summary
A sentinel lymph node (SLN) is any lymph node that directly receives lymph drainage from a tumor site (Uren et al 2003). Uren et al (2003) reported that SLNs need not necessarily. Computed tomography lymphography (CT-LG) involves CT after locally injecting a contrast agent. It can be conveniently performed, and the morphology and location of both lymphatic routes and SLNs can be visualized in detail, with minimal invasiveness (Yamamoto et al 2016). It is important to completely understand the anatomy and number of lymphatic routes and SLNs and their location. The location and flow direction of SLNs have been studied in cadavers (Suami et al 2009a, b) and by the radioisotope method (Blumgart et al 2011a, b), but the anatomical morphology of lymphatic routes and SLNs using CT-LG has not been extensively studied since the report of Yamamoto et al (2016).
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