Preoperative diagnosis of sentinel lymph node (SLN) metastasis using 3D CT lymphography (CTLG)

Nakagawa, Misako; Morimoto, Masami; Takechi, Hirokazu; Tadokoro, Yukiko; Tangoku, Akira

doi:10.1007/s12282-015-0597-8

Cited by 36 publications

(31 citation statements)

References 21 publications

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“…The same region of interest was drawn and copied for the measurements of each lymph node in all subsequent series. Mean, minimum and maximum HU values were recorded. Enhancement pattern of the lymphatic vessels (not assessable vs. stagnant, dilated, or detoured lymph vessel) . For better identification of the pathways of the lymphatic vessels, additional multiplanar and maximum intensity projection reformatted images were created.…”

Section: Methodsmentioning

confidence: 99%

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Computed tomographic‐lymphography as a complementary technique for lymph node staging in dogs with malignant tumors of various sites

Rossi

Körner

Suarez

et al. 2017

Vet Radiology Ultrasound

112

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Locoregional lymph nodes are routinely examined in order to define the spatial extent of neoplastic disease. As draining patterns of certain tumor types can be divergent from expected anatomical distribution, it is critical to sample the lymph nodes truly representing the draining area. The aim of this bicenter prospective pilot study was to describe the technique of computed tomographic (CT)-lymphography for primary draining lymph node mapping in tumor staging in dogs. Forty-five dogs with macro- or microscopic tumors in specified localizations were evaluated. Depending on body weight, 0.8-2 ml contrast agent (iohexol) was injected into four quadrants around the tumor, and CT-images were obtained at 1, 3, 6, 9, and 12 minutes post-injection. Attenuation of chosen regions of interest (Hounsfield units (HU)) and patterns of enhancement were assessed for 284 lymph nodes in the precontrast study with median HUs of 31.1 (Interquartile range (IQR) = 18.4) and for 275 in the intravenous postcontrast study with 104.3 HU (IQR = 31.2) (paired Wilcoxon test, P < 0.001). In the CT-lymphography study, 45 primary draining lymph nodes with a significantly higher median HU value of 348.5 (IQR = 591.4) (one-sample t-test, P < 0.001) were identified. Primary draining lymph nodes were found to be clearly visible after 1-3 minutes after local injection, often concurrent with a good visibility of the lymphatic vessel system. The herein described technique of peritumorally injected CT-contrast agent followed by subsequent CT-lymphography for primary draining lymph node mapping works well in a majority of cases in all investigated sites and warrants further validation for different tumor entities.

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Section: Methodsmentioning

confidence: 99%

“…Enhancement pattern of the lymphatic vessels (not assessable vs. stagnant, dilated, or detoured lymph vessel) . For better identification of the pathways of the lymphatic vessels, additional multiplanar and maximum intensity projection reformatted images were created.…”

Section: Methodsmentioning

confidence: 99%

Computed tomographic‐lymphography as a complementary technique for lymph node staging in dogs with malignant tumors of various sites

Rossi

Körner

Suarez

et al. 2017

Vet Radiology Ultrasound

112

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“…Takahashi et al [7] used CT-LG to identify SLNs of 218 breast cancer patients. Nakagawa et al [19] used CT-LG to detect SLN metastases of the breast in 228 patients. Suga et al [20] identified breast SLNs using MRI-LG in volunteers.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Dynamic Observation of the Color Change and Enhancement Effect of Polyethylenimine-Entrapped Gold Nanoparticles Used for Indirect Lymphography

Yang

Shi²,

Zhou³

et al. 2016

ORL

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Aims: To dynamically observe the color change and enhancement effect of gadolinium-loaded polyethylenimine-entrapped gold nanoparticles (Gd-Au PENPs) as a dual-mode CT/MRI contrast agent for sentinel lymph node (SLN) identification. Methods: In 6 rabbits, Gd-Au PENPs were injected into the right side tongue submucosa, after which the color change of cervical draining lymph nodes was observed. Then the draining lymph nodes were examined by CT/MRI scan. Another 6 rabbits were randomly divided into a CT lymphography (CT-LG) and a MRI lymphography (MRI-LG) group and examined by CT/MRI scan 1 and 30 min after injection. Then SLNs were identified under the guidance of CT/MRI-LG. Results: The ipsilateral afferent lymphatic vessels, cervical draining lymph nodes and efferent lymphatic vessels were stained black orderly and constantly after Gd-Au PENPs injection. Thirty minutes after injection, all cervical lymph nodes were excised to be examined by CT/MRI scan, and only the black-stained draining lymph nodes were enhanced. The 6 rabbits with CT/MRI-LG showed clear enhancement of SLNs. With indirect lymphography, the black-stained SLNs were easily visualized at autopsy. In all rabbits, the identification rate of lingual SLNs was 100%. Conclusions: Rabbit lingual SLNs could be identified with indirect lymphography using Gd-Au PENPs as a dual-mode contrast agent.

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“…Sentinel nodes that are not stained or poorly stained (<50%) suggest presence of metastasis [34]. Other criteria used by some authors are partial staining of sentinel nodes (stain defect, mottled or ‘crab claw' stain), stagnant or dilated lymph vessels, and detoured lymph vessels [35]. The sentinel nodes are marked on the skin using a laserlight navigator system.…”

Section: Non-operative Axillary Stagingmentioning

confidence: 99%

“…The sentinel node detection rate for CTLG preoperatively ranges from 98 to 100% and for CTLG-assisted sentinel node biopsy is 100% [34,35,36]. However, CTLG alone has an unacceptably high false-negative and false-positive rate for macrometastases (17.9 and 16.4%, respectively) [34].…”

Section: Non-operative Axillary Stagingmentioning

confidence: 99%

New Technologies for Sentinel Lymph Node Detection

Goyal¹

2018

Breast Care

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The ‘standard of care' method for sentinel node mapping is the combination technique using radioisotope and blue dye although some centres use radioisotope or blue dye alone. Radioisotope usage requires licensing, has regulatory issues around handling and disposal of waste, and logistically may be unavailable or difficult to implement in some centres or less developed country. This has led to the development of alternative methods such as superparamagnetic iron oxide (SPIO), fluorescence techniques using indocyanine green (ICG) or fluorescein, computed tomography lymphography, and contrast-enhanced ultrasound scan (CEUS) using microbubbles. The newer techniques will potentially enable a more widespread adoption of this procedure; however, a common barrier for these techniques is the lack of standardisation and no randomised trials to evaluate their effectiveness against the current standard of care. Furthermore, many of these techniques are more costly and may become redundant in node-negative patients with small tumours if ongoing trials show that sentinel node biopsy offers no additional benefit to grey-scale axillary ultrasound. This review discusses the new techniques for sentinel node mapping that have emerged including their pros and cons.

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Preoperative diagnosis of sentinel lymph node (SLN) metastasis using 3D CT lymphography (CTLG)

Abstract: CTLG can select the candidate with truly node negative cases in early breast cancer patients, because it predicts lymph node metastasis preoperatively from natural status of the lymphographic image. It also might omit the SLN biopsy itself.

Cited by 36 publications

References 21 publications

Computed tomographic‐lymphography as a complementary technique for lymph node staging in dogs with malignant tumors of various sites

Computed tomographic‐lymphography as a complementary technique for lymph node staging in dogs with malignant tumors of various sites

Short-Term Dynamic Observation of the Color Change and Enhancement Effect of Polyethylenimine-Entrapped Gold Nanoparticles Used for Indirect Lymphography

New Technologies for Sentinel Lymph Node Detection

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