Evaluation of sentinel lymph node metastasis alone guided by three-dimensional computed tomographic lymphography in video-assisted breast surgery

Abstract

Detailed relations between lymph nodes and lymph flow can be clarified by three-dimensional computed tomographic (3D-CT) lymphangiography. Systematic collection of lymph nodes based on 3D-CT lymphangiography can decrease unnecessary lymph node dissection and attendant complications. To mark the sentinel lymph node (SLN) on the skin, 3D-CT lymphangiography was performed the day before the surgery. Iopamiron 300 (2 ml) was injected subcutaneously. A 16-channel multidetector-row helical CT scan image was reconstructed to produce a 3D image of lymph ducts and lymph nodes. Biopsy of SLN was performed by a dye-staining method using Visiport-aided endoscopy. Stained lymph nodes were located by following the dye in the lymph ducts on a video monitor. For SLN-metastasis-positive patients, standard axillary lymph node dissection (levels 1 and 2) was performed with video assistance. Since December 2001, video-assisted breast surgery has been performed for 180 patients, SLN biopsy for 150 patients, and 3D-CT lymphangiography for 110 patients. Findings show that SLN-positive metastasis (n = 31) was accompanied by SLN metastasis alone in 14 patients. One-node metastasis, except for SLN, was observed in seven patients, two-node metastasis in three patients, and metastasis involving more than three nodes in seven patients. Review of the lymphoid path using 3D-CT lymphangiography confirmed that metastasis occurred in order of lymph flow. Absence of metastasis in the second and third SLNs, even in patients with SLN metastasis, obviates the need for dissection of more nodes.