CT lymphography-guided sentinel lymph node biopsy

Authors summarized their feasibility studies for clinical significance of CT lymphography-guided sentinel lymph node (SLN) mapping and biopsy in the breast, lung and esophageal cancers, with use of a recently developed water-soluble contrast medium, iopamidol. Subjects with breast cancers were 68 patients of the mean age 58 years old with the mean tumor size 21 mm. Local anesthesia was done by intradermal and subcutaneous injections of lidocaine, iopamidol was injected around the tumor, and 3D-CT was then conducted 20-30 sec later with the 4-row multidetector CT equipment, Siemens Somatom Volume Zoom. The CT was completed within 10-15 min with exposure doses of 14-18 mGy. Biopsy was then performed according to the 3D-CT map. Subjects with early stage lung and esophageal cancers were each 9 patients (mean ages 63 and 66 y) with the mean tumor size 21 mm and operable one, respectively. 3D-CT and biopsy were conducted essentially similarly to above. Shortly after injection of the contrast medium, all pathways of lymph ducts from the tumor to SLN were imaged, based on whose map biopsy was possible. This procedure can be practically useful for identification and biopsy of SLN in those cancers. (T.I.)