O1-7-6 - Endoscopic Sentinel Node Biopsy Can Be Navigated by the Fusion Image of 3D-Ct Lymphography and Spect-Ct

Abstract

Background: 3D-CT mannmary lymphography (LG) can image the detail lymphatic map from the breast gland to the axillary nodes (AN) and can enable us to detect the precise sentinel node (SN) and to perform the endoscopic SN biopsy easily. It can also detect the second and the third SN on the lymphatic map. These node biopsy will contribute to omit AN dissection on the SN-positive patients. Now we try to overlay the fusion image of SPECT on the endoscopic view, and evaluate its real-time navigation of endoscopic surgery.Methods: 3D-CT LG was performed by the subcutaneous injection of 2 ml Iopamidol 300 above the tumor and near areola, and by taking CT images at 1 minute. They were reconstructed to produce a 3D image of lymph ducts and lymph nodes by the volume rendering method. SPECT was performed by injection of 99mTc phytate 74mBq and taking images after 2 hours. SN biopsy and AN dissection were performed by dye and RI method using endoscope with the optical trocar Visiport through only 1 cm long skin incision, and overlaying 3D-CT image on the endoscopic view with free-hand SPECT.Results: We have performed the endoscopic SN biopsy on 350 patients. The SN metastasis was found on 80 patients: single SN metastasis on 32, the second SN on 8, and the third SN on 7. The fusion image of 3D-CT LG and SPECT enable us to identify the anatomical position of SN on AN map by RI detector probe, and to introduce the endoscope by the overlay system. It also enable us to get the second SN easily. The axillary node metastasis was not observed on the patients without second SN metastasis. There was no false negative study. There is no local recurrence at 10 years after surgery.Discussions: The overlay of 3D-CT LG on the endoscopic view improve the identification rate of SN and the manipulation of the endoscopic surgery. We are developing these visual processing technique to apply the real-time navigation for the endoscopic partial mastectomy.