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Localization and Evaluation of Sentinel Lymph Node in Breast Cancer From Computed Tomographic Lymphography

Tan, Hongna PhD*†; Yang, Benlong MD†‡; Wu, Jiong MD†‡; Wana, Shengping PhD*†; Gu, Yajia MD*†; Li, Wentao MD*†; Jiang, Zhaoxia PhD*†; Qian, Min BS*†; Peng, Weijun MD*†

Journal of Computer Assisted Tomography: May/June 2011 - Volume 35 - Issue 3 - pp 367-374
doi: 10.1097/RCT.0b013e318213ccd9
Breast Imaging

Objective: This study aimed to determine the accuracy of computed tomographic (CT) localization and CT-based diagnosis of sentinel lymph nodes (SLNs) metastasis.

Methods: Thirty-four patients with confirmed breast cancer underwent 40-row CT scanning, and the first one or several lymph node(s) in the lymphatic drainage pathway was/were defined as the SLN(s). Dye and γ probe-guided SLN biopsy was performed on all patients. To accurately localize the SLN, 19 patients (55.9%) underwent the percutaneous lymph node puncture procedure. The morphologic features of all the SLNs on CT scans were analyzed and compared with the SLN biopsy pathologic diagnosis.

Results: Sentinel lymph nodes were successfully identified for all patients without any significant adverse effects. All localized SLNs corresponded well with SLNs identified on SLN biopsy, with an accuracy of 89.5%. Accuracy increased to 100% when the CT scan technique was combined with the blue dye method. The size criteria for metastatic diagnosis had a sensitivity of 85%, which increased to 94.7% when long-to-short-axis ratio and margin characteristics were also considered.

Conclusions: The CT lymphography combined with the blue dye method accurately localized the SLNs. The CT-based diagnostic criteria improved the diagnostic accuracy of SLN metastases and were useful for evaluating the axillary status in early stage breast cancer patients.

From the Departments of *Radiology, and †Breast Surgery, Cancer Hospital/Institute, and ‡Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

Received for publication November 22, 2010; accepted February 2, 2011.

Reprints: Weijun Peng, MD, Department of Radiology, Cancer Hospital/Cancer Institute and Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong-An Rd, Shanghai 200032, China (e-mail: cjr.pengweijun@vip.163.com).

© 2011 Lippincott Williams & Wilkins, Inc.