Tianjin Medical Journal

Tianjin Medical Journal ›› 2022, Vol. 50 ›› Issue (3): 291-295.doi: 10.11958/20212150

Previous Articles     Next Articles

Application of CT three-dimensional reconstruction in the assessment of sentinel lymph node status and drainage pathways in breast cancer

MA Xiaokai, GUO Fei, ZHU Jinhai, ZHU Lin, CHEN Chunchun, HUANG Jiankang, MA Yichuan   

  1. 1 The First Department of Thyroid and Breast Surgery, 2 Department of Radiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
  • Received:2021-09-16 Revised:2021-11-09 Published:2022-03-15 Online:2022-03-15

PDF (PC)

2566

Abstract: Objective　To explore the application value of using CT three-dimensional (3D) reconstruction method in assessing the status of the sentinel lymph node (SLN) and its drainage pathway in breast cancer. Methods　Computed tomography lymphodography (CT-LG) was performed in 23 patients who were diagnosed with breast cancer underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). After 3D volume reconstruction, the image showed SLN and the drainage lymphatic vessels. The metastasis of the SLN was evaluated by imaging features, such as the morphology and filling of lymph nodes, and compared with the postoperative pathological results. SLN and its connected lymphatic vessels displayed by CT-LG were compared with the SLN and its connected lymphatic vessels dissected during SLNB operation to further verify the clinical application value of CT 3D reconstruction. Results　A total of 20 patients were successfully detected, with a detected rate of 86.9%. The number of SLN detected by SLNB was significantly higher than that detected by CT-LG (Z=3.568, P＜0.01). An unconventional drainage pathway SLN was found before the operation through CT-LG technology, which was sent out from the lymphatic plexus in the areola and entered the posterior breast space through the glandular layer. Among 34 lymph nodes displayed by CT-LG, 26 were pathologically negative, of which 20 lymph nodes showed uniform filling, 6 showed filling defects, and 8 were pathologically positive, all showing filling defects. The proportion of filling defects in pathologically positive SLN lymph nodes was higher than that of pathologically negative SLN (P＜0.01). Conclusion　The CT 3D reconstruction method is helpful for the precise positioning of sentinel lymph nodes, and it can also find the SLN of unconventional drainage pathways. For imaging manifestations of filling defects, tumor cell infiltration should be considered.

Key words: breast neoplasms, sentinel lymph node biopsy, lymphography, CT three-dimensional reconstruction, filling defect