2005 Fiscal Year Final Research Report Summary
Sentinel lymph node biopsy in lung cancer with CT lymphography
| Project/Area Number |
16591206
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Radiation science
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| Research Institution | Yamaguchi University |
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Principal Investigator |
SUGA kazuyoshi YAMAGUCHI UNIVERSITY HOSPITAL, RADIOLOGY, ASSOCIATE PROFESSOR, 医学部附属病院, 助教授 (90171115)
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| Co-Investigator(Kenkyū-buntansha) |
MATSUNAGA Naofumi YAMAGUCHI UNIVERSITY HOSPITAL, RADIOLOGY, PROFESSOR, 医学部, 教授 (40157334)
KANEDA Yoshikazu YAMAGUCHI UNIVERSITY HOSPITAL, RADIOLOGY, RESEARCH ASSOCIATE, 医学部附属病院, 助手 (70325223)
FUJITA Takeshgi YAMAGUCHI UNIVERSITY HOSPITAL, RADIOLOGY, RESEARCH ASSOCIATE, 医学部, 助手 (50335733)
SHIMIZU kensaku YAMAGUCHI UNIVERSITY HOSPITAL, RADIOLOGY, RESEARCH ASSOCIATE, 医学部附属病院, 助手 (80363109)
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| Project Period (FY) |
2004 – 2005
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| Keywords | Lung cancer / Sentinel lymph node / Computed tomography / Lymphography / Lymph node biopsy / Contrast medium |
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| Research Abstract |
We experimentally and clinically evaluated the potential utility of indirect computed tomographic lymphography (CT-LG) with intrapulmonary injection of iopamidol for preoperative localization of sentinel lymph node station in non-small cell lung cancer. CT-LG with intrapulmonary injection of 0.5 ml of undiluted iopamidol was performed in 10 dogs using a multidetector-row CT unit, followed by postmortem examination of enhanced lymph nodes in 5 of these dogs. The CT-LG with peritumoral injection of 1 ml of the contrast agent was also performed in 9 patients with non-small cell lung cancer without lymphadenopathy. This clinical study was approved by the Yamaguchi University Hospital Institutional Review Board, and informed consent was obtained from all patients after the nature of the procedures and possible side effects such as pneumothorax and hemorrhage have been fully explained. At surgery, enhanced lymph nodes were resected under CT-LG guide, followed by standard lymph node dissectio
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n with macroscopic and histologic examination. A significant enhancement of lymph nodes was determined when CT attenuation value was increased with 30 Hounsfield unit (HU) compared with pre-contrast images.
CT-LG visualized a total of 15 enhanced lymph nodes (on average, 1.5 nodes per animal) within 2 min after contrast injection in the 10 dogs, with average size of 6.7+/-1.9 mm and average maximum CT attenuation of 149+/-41 HU. All the 8 enhanced nodes in 5 dogs were found in the appropriate anatomic locations in postmortem examinations. Without noticeable complications, CT-LG visualized 30 ipsilateral intrathoracic lymph nodes including 19 hilar/pulmonary and 11 mediastinal nodes in the 9 patients (on average, 2.2 hilar/pulmonary and 1.1 mediastinal nodes per patient) within 2 min after contrast injection, with average size of 4.7+/-0.4 mm and average maximum CT attenuation of 134+/-52 HU. At surgery, all these enhanced nodes could be accurately found and resected under CT-LG guidance. Metastasis was not evident in either of these enhanced lymph nodes or the remaining distant nodes in all patients. Quick and accurate localization of sentinel lymph node station on detailed underlying lung anatomy by using indirect CT-LG may be of value to guide selective lymph node dissection for minimally invasive surgery in non-small cell lung cancer. Less
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