Sentinel nodes identified by computed tomography-lymphography accurately stage the axilla in patients with breast cancer

Kazuyoshi Motomura,Takashi Horinouchi,Katsuyuki Nakanishi,Hiroshi Sumino,Atsushi Noguchi

doi:10.1186/1471-2342-13-42

Kazuyoshi Motomura, Takashi Horinouchi + Show 3 more

Open Access

https://doi.org/10.1186/1471-2342-13-42

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Abstract

BackgroundSentinel node biopsy often results in the identification and removal of multiple nodes as sentinel nodes, although most of these nodes could be non-sentinel nodes. This study investigated whether computed tomography-lymphography (CT-LG) can distinguish sentinel nodes from non-sentinel nodes and whether sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer.MethodsThis study included 184 patients with breast cancer and clinically negative nodes. Contrast agent was injected interstitially. The location of sentinel nodes was marked on the skin surface using a CT laser light navigator system. Lymph nodes located just under the marks were first removed as sentinel nodes. Then, all dyed nodes or all hot nodes were removed.ResultsThe mean number of sentinel nodes identified by CT-LG was significantly lower than that of dyed and/or hot nodes removed (1.1 vs 1.8, p <0.0001). Twenty-three (12.5%) patients had ≥2 sentinel nodes identified by CT-LG removed, whereas 94 (51.1%) of patients had ≥2 dyed and/or hot nodes removed (p <0.0001). Pathological evaluation demonstrated that 47 (25.5%) of 184 patients had metastasis to at least one node. All 47 patients demonstrated metastases to at least one of the sentinel nodes identified by CT-LG.ConclusionsCT-LG can distinguish sentinel nodes from non-sentinel nodes, and sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. Successful identification of sentinel nodes using CT-LG may facilitate image-based diagnosis of metastasis, possibly leading to the omission of sentinel node biopsy.

Highlights

Sentinel node biopsy often results in the identification and removal of multiple nodes as sentinel nodes, most of these nodes could be non-sentinel nodes
One of the most important issues is how many and which axillary lymph nodes need to be removed as sentinel nodes for accurate axillary staging
This study investigated whether Computed tomography (CT)-LG can distinguish sentinel nodes from non-sentinel nodes by visualization of the lymphatic channel and whether sentinel nodes identified by computed tomography-lymphography (CT-LG) can accurately stage the axilla in patients with breast cancer

Summary

Introduction

Sentinel node biopsy often results in the identification and removal of multiple nodes as sentinel nodes, most of these nodes could be non-sentinel nodes. Sentinel node biopsy has been established as a standard of care in the treatment of breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection [1,2,3,4,5]. Sentinel node biopsy using dye and/or radioisotopes often results in the identification and removal of Recently, sentinel nodes have been reported to be wellidentified using computed tomography-lymphography (CT-LG) in patients with breast cancer [15,16,17,18,19]. Lymph flow and sentinel nodes were successfully visualized by interstitial injection of CT contrast agent

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