Sentinel lymph node detection in breast cancer patients by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography.

Abstract

#1026 Background: Ultrasonography (US) is one tool for preoperative diagnosis of lymph node metastases in breast cancer. However, US cannot detect true sentinel lymph nodes (SLNs).
 Methods: We identified SLNs in 60 clinically node-negative breast cancer patients using a real-time virtual sonography (RVS) system to display in real time a virtual multi-planar reconstruction obtained from computed tomography (CT) volume data corresponding to the same cross-sectional image from US. CT volume data were obtained from our original three-dimensional CT lymphography (3DCT-LG), which accurately detects SLNs in breast cancer. SLN metastases were assessed by shape and visibility of the hilum. All patients underwent SLN biopsy and SLN metastases were examined pathologically.
 Results: In all 60 patients, we were able to detect the same SLNs visualized by 3DCT-LG. Suspicious SLN metastases were identified in 7 of the 60 patients, and 4 of 7 patients were pathologically positive. Positive predictive value was 57%. The remaining 53 patients displayed non-suspect SLNs in which absence of metastasis from the SLN was confirmed histologically. Overall accuracy was 95%.
 Conclusions: This is a first attempt at preoperatively identifying SLNs using US guided by the RVS system in breast cancer patients. Although evaluation of SLN metastases was unsatisfactory, this method may be useful for preoperative fine-needle aspiration cytology for diagnosis of SLN metastases. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1026.

Prospective ultrasonographic prediction of sentinel lymph node metastasis by real-time virtual sonography constructed with three-dimensional computed tomography–lymphography in breast cancer patients

“…Nakano et al [10] first reported that RVS systems can identify enhancing breast lesions visualized with MRI with excellent accuracy. We recently reported that RVS systems can identify SLNs by using data from CT lymphography [9]. In the present study, we used an RVS system and 3DCT-LG to preoperatively detect SLNs and evaluate SLN status by US.…”

“…A real-time virtual sonography (RVS) system [8] was recently developed that shows in real time the virtual multiplanar reconstruction (MPR) CT image corresponding to the image from ultrasonography (US). We have applied RVS conducted using 3DCT-LG to the preoperative detection of SLNs and prediction of SLN metastasis in breast cancer patients [9]. Preoperative ultrasonographic diagnosis of metastasis in axillary lymph nodes may prove useful.…”

What’s up in nanomedicine?

“…Sentinel lymph nodes are likely involved in the spread of tumor cells and therefore the status of these nodes are seen as an independent additional factor in the prognosis in disease (1). Diagnostic techniques such as ultrasound, magnetic resonance imaging and histological confirmation (biopsy) are used to investigate a possible metastasis to the sentinel lymph nodes (2)(3)(4). In the case of head and neck cancer, where a metastasis is confirmed, the removal of the sentinel lymph node is the primary option to increase the survival rate of the patient (5).…”

“…As an example, the work of Karakatas et al (20) was used, who showed in their publication a mitochondrion covered with 565 gold nanoparticles (13 nm diameter). From the calculations it was concluded that the dose enhancement ratios [1] were the highest in the kilovolt range, [2] depend on the dimensions of the mitochondrion, [3] the number of gold nanoparticles, and [4] the thickness of the gold nanoparticle coating. The presented work suggests further investigation of the role of the mitochondrium in cellular response to radiation and a novel possibility for radiation therapy where the mitochondria are the target.…”

“…The generated nano-proresolving medicine is transferred to the serum membrane receptors of bone cells and as well to the leukocytes regulating their responses to stimulate the formation of bone. While the bone is remodeled, the biofilm environment is controlled as a result of the cellular events, which are initiated by benzo-lipoxin A 4 . This further results in an up regulation of the endogenous proresolving lipid mediators and direct actions on the bone cells which influences osteogenesis.…”