2004 Fiscal Year Final Research Report Summary
CT/MR-guided sentinel lymph node mapping of breast cancer
| Project/Area Number |
15591279
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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 |
KARINO Yuichi YAMAGUCHI UNIVERSITY, UNIVERSTY HOSPITAL, RESEARCH ASSOCIATE, 医学部附属病院, 助手 (30186035)
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| Co-Investigator(Kenkyū-buntansha) |
MATSUNAGA NAOFUMI YAMAGUCHI UNVERSITY, SCHOOL OF MEDICINE, PROFESSOR, 医学部, 教授 (40157334)
SUGA KAZUYOSHI YAMAGUCHI UNVERSITY, UNIVERSITY HOSPITAL, ASSOCIATE PROFESSOR, 医学部附属病院, 助教授 (90171115)
TANGOKU AKIRA YAMAGUCHI UNIVERSITY, SCHOOL OF MEDICINE, ASSOCIATE PROFESSOR, 医学部, 助教授 (10197593)
ITO ATSUYOSHI YAMAGUCHI UNIVERSITY, UNIVERSITY HOSPITAL, ASSISTANT PROFESSOR, 医学部附属病院, 講師 (00274168)
FUJITA TAKESHI YAMAGUCHI UNIVERSITY, SCHOOL OF MEDICINE, RESEARCH ASSOCIATE, 医学部, 助手 (50335733)
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| Project Period (FY) |
2003 – 2004
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| Keywords | Computed tomography (CT) / Breast cancer / Sentinel lymph node / Contrast material / Magnetic resonance imaging (MRI) / 造影剤 |
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| Research Abstract |
Three-dimensional multidetector-row computed tomographic lymphography (3D MDCT-LG) with interstitial injection of a widely-available nonionic monometric contrast medium iopamidol was used for navigation of breast sentinel lymph node (SLN) biopsy.
3D MDCT-LG was obtained after massage of the interstitially injection sites of a total of 4-5 ml undiluted iopamidol at periareolar and peritumoral areas in 68 consecutive patients with early-stage breast cancer, using a four detector-row CT scanner. Drainage lymphatic patterns and SLN anatomy were assessed on 3D MDCT-LG images. 3D MDCT-LG-navigated SLN biopsy with combined use of blue dye was followed by backup axillary lymph node dissection to evaluate accuracy of SLN biopsy.
The 3D MDCT-LG images clearly localized primary SLNs by visualizing the direct connection between these nodes and their afferent lymphatic vessels on detailed anatomy of the surrounding structures in all patients. Drainage lymphatic pathways on these images was classified into four patterns : single route/single SLN (39 cases, 57%), multiple routes/multiple SLNs (10 cases, 15%), single route/multiple SLNs (9 cases, 13%) and multiple routes/single SLN (10 cases, 15%). Under 3D MDCT-LG navigation, SLNs was found at the accurate location in all patients. With backup axillary lymph node dissection, metastasis was found in 14 (20%) patients, and 8 of these patients had metastasis only in the preoperatively identified SLNs. In other 5 positive patients, metastasis was found both in the SLN and non-SLNs. However, micrometastasis was eventually found only in non-SLN in an elderly patient. Overall, The sensitivity, false negative rate and accuracy of 3D CT -L-navigated SLN biopsy were 92% (13/14), 7% (1/14), and 98% (67/68), respectively.
Topographic 3D interstitial MDCT-LG can be a widely-available and reliable navigator for breast SLN biopsy.
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