Abstract
BackgroundCombining a radioisotope with a dye-guided method is the best method for identification of the sentinel lymph nodes (SNs) in breast cancer. However, some institutions are limited to use of a dye-guided method alone. Recently, computed tomographic lymphography (CTLG) employing a nonionic contrast medium has achieved SN identification.Patients and methods218 patients with primary breast cancer and no clinical evidence of lymph node metastasis were studied. SN identification was performed by CTLG and a dye-guided method. The SN identification rate was analyzed for correlations with the clinicopathological findings.ResultsThe SN identification rates were 96% with CTLG, 92% with the dye-guided method and 99% with both methods combined. The identification rates with CTLG and the combined method were significantly lower in node-positive patients compared to node-negative patients, and significantly lower with the combined method in vascular invasion-positive patients compared to negative patients. In addition, the SN identification rate with the dye-guided method was significantly lower in patients with a body mass index (BMI) of ≥ 25, whereas the BMI did not affect the identification rate with CTLG or the combined method. Multiple SNs were detected in approximately 20% of the patients.ConclusionCombined performance of CTLG and a dye-guided method enables identification of SNs prior to breast cancer surgery. That SN identification is easier compared with by the dye-guided method alone, and the identification rate is improved compared with either method alone. The combination of methods was especially useful in obese patients. For patients with multiple SNs, the combination has the further advantage of enabling accurate SN biopsy. CTLG may yield false-negative findings in node-positive patients and patients with lymph vessel obstruction.
Highlights
Combining a radioisotope with a dye-guided method is the best method for identification of the sentinel lymph nodes (SNs) in breast cancer
That sentinel nodes (SN) identification is easier compared with by the dyeguided method alone, and the identification rate is improved compared with either method alone
In 7 other patients (3%), the lymph vessels were enhanced while the lymph nodes were not clearly enhanced, but the SNs could be identified from the CT value
Summary
Combining a radioisotope with a dye-guided method is the best method for identification of the sentinel lymph nodes (SNs) in breast cancer. Computed tomographic lymphography (CTLG) employing a nonionic contrast medium has achieved SN identification. The RI method can be performed only at institutions that are trained and licensed to use RI, and other institutions must rely on dye methods alone for SN identification [4,5,6,7,8] On the other hand, for obtaining images of the lymph vessels and nodes, indirect lymphography seems to be a more convenient than direct intralymphatic administration of a contrast medium. We have been identifying SN in breast cancer patients by CTLG and a dye-guided method since February 2003 as a clinical trial [5]. We report our findings to date regarding the clinical efficacy and problems associated with SN identification by the combination of CTLG and a dye-guided method
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