■綜説
乳腺内視鏡手術と3D-CT乳腺リンパ管造影＜その2＞3D-CT乳腺リンパ管造影によるセンチネルリンパ節生検
山下 浩二
日本医科大学大学院医学研究科機能制御再生外科学
Video-Assisted Breast Surgery and 3-Dimensional Computed Tomographic Mammary Lymphography <2> Sentinel Node Biopsy with 3D-CT Mammary Lymphography
Koji Yamashita
Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School
Background: I have studied endoscopic surgery for breast diseases and 3-dimensional (3D) computed tomographic (CT) lymphography for sentinel node (SN) biopsy. In this second in a series of reports, I explain the techniques of 3D-CT lymphography. 3D-CT lymphography can show the detailed lymphatic flow from the breast tumor toward the SNs and the exact local relation between axillary lymph nodes. I have developed this 3D image-processing system to more precisely depict the anatomical structures of the mammary lymphovascular system. This system allows us to systematically collect axillary lymph nodes, including SNs.
Methods: 3D-CT lymphography was performed to mark SNs on the skin on the day before surgery. Above the tumor and near the areola, 2 ml of Iopamiron 300 was injected subcutaneously. Sixteen-channel multidetector-row helical CT scan images were obtained 1 minute after injection to detect SNs, and after 3 and 5 minutes to observe lymph flow into the venous angle. The scan images were reconstructed to produce 3D images. SN biopsy was performed with the dye-staining method and endoscopy.
Results: 3D-CT lymphography accurately showed lymphatic flow from the tumor to SNs. We classified the relationship between the lymph ducts and the drained SNs into 4 patterns. Following up 3 and 5 minutes after injection of the contrast agent, we can follow the lymph ducts beyond the SN into the second and third nodes toward the venous angle with the complex plexus. The figure of the axillary nodes shows 5 beads-like grouped nodes. 3D-CT lymphography can also recognize the metastatic patterns of the enhanced lymph node. These patterns will predict the metastasis before SN biopsy. 3D-CT lymphography can also be used to detect lymph flow from the arm to avoid harming the arm lymph channel during axillary node dissection and SN biopsy.
Conclusions: With 3D-CT lymphography, we can more accurately and precisely recognize lymph flow and the positional relations of SN and axillary nodes to surrounding anatomical structures.
日医大医会誌 2010; 6(3), 111-117
Key words
breast cancer, endoscopic surgery, sentinel node biopsy, 3-dimensional computed tomographic lymphography, aesthetic results
Correspondence to
Koji Yamashita, Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：yamasita@nms.ac.jp
受付：2009年11月30日 受理：2010年4月23日 |
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