Sentinel and axillary nodes of the breast distinguished from those of the arm by 3D-CT lymphography and selectively dissected by endoscopic surgery

Abstract

616 Background: In early breast cancer, the presence of metastasis in axillary lymph nodes (AN) is an important factor in prognosis and further treatment. However, AN dissection causes many complications such as contracture of shoulder joint, lymph edema, and paralysis of upper extremities. Sentinel node (SN) biopsy provides us valuable information about no need to dissect AN for node-negative patients. However, on node-positive patients, the conventional AN dissection has been performed. 3D-CT lymphography (LG) can show the precise individual lymphatic flow not only from the breast tumor to SN but also from SN to venous angle, which means breast lymphatic channel. We applied 3D-CT LG to distinguish them from the arm channel to avoid any arm complications. Methods: 3D-CT LG was performed on the day before surgery to mark SN on the skin. Above the tumor and near the areola and the arm pit, 2 ml of Iopamidol 300 was injected subcutaneously. Images of 16-channel multidetector-row helical CT scan were taken at 1, 3, and 5 min after injection. They were reconstructed to produce a 3D image of lymph ducts and lymph nodes. SN biopsy and AN sampling were performed by dye-staining method using endoscopy. Results:We performed SN biopsy with 3D-CT LG on 160 patients. 3D-CT LG clearly showed the precise lymphatic flow from the tumor to SN. It can show SN at only one min after injection. But following up to 5 min, we can follow the lymph ducts beyond SN into the second to the fifth node groups toward the venous angle with complex plexus, observed in the surrounding anatomical architecture. Detection rate was 100% for SN; 80% for the third group; and 30% for the fifth group. The arm lymph flow was distinguished by the connections between the breast and the arm flow, observed 39% and 71% in the fourth and the fifth group. SN was shared from between the breast and the arm in 5 patients (3.1%). They complained arm edema only by SN biopsy. We can distinguish and sample AN drained from the breast, guided by 3D-CT LG and dye-staining using endoscopy. Conclusions:By 3D-CT LG, we can recognize the accurate and more precise lymph flow in the surrounding anatomical architecture. It helps us easily to pursuit lymph flow and to remove SN and AN from the breast selectively using endoscopic surgery. No significant financial relationships to disclose.