Published online before print December 29, 2003, 10.1148/radiol.2302021380
Breast Sentinel Lymph Node Mapping at CT Lymphography with Iopamidol: Preliminary Experience1
Kazuyoshi Suga, MD,
Yue Yuan, MD,
Munemasa Okada, MD,
Naofumi Matsunaga, MD,
Akira Tangoku, MD,
Shigeru Yamamoto, MD and
Masaaki Oka, MD
1 From the Departments of Radiology (K.S., Y.Y., M. Okada, N.M.) and Second Surgery (A.T., S.Y., M. Oka), Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan. Received October 30, 2002; revision requested January 7, 2003; final revision received July 12; accepted August 22. Address correspondence to K.S. (e-mail: sugar@po.cc.yamaguchi-u.ac.jp).
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Figure 1a. Patient 4. Images in patient with 28 x 20-mm breast tumor in left lower outer quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. Left: Surface rendering. Right: Maximum intensity projection. Lymphatic pathways are substantially enhanced with interstitially injected iopamidol. Drainage lymphatic vessels (long arrows) from peritumoral and periareolar injection sites (arrowheads) drain into single axillary SLN at level I (short arrows). Several distant nodes (curved arrows) up to axillary level II also show enhancement. P = periareolar area, T = tumor site.
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Figure 1b. Patient 4. Images in patient with 28 x 20-mm breast tumor in left lower outer quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. Left: Surface rendering. Right: Maximum intensity projection. Lymphatic pathways are substantially enhanced with interstitially injected iopamidol. Drainage lymphatic vessels (long arrows) from peritumoral and periareolar injection sites (arrowheads) drain into single axillary SLN at level I (short arrows). Several distant nodes (curved arrows) up to axillary level II also show enhancement. P = periareolar area, T = tumor site.
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Figure 2a. Patient 7. Images in a patient with 12 x 11-mm breast tumor in the right lower outer quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. Top left: Maximum intensity projection 3D image. Bottom left: Surface-rendered image. Right: Maximum intensity projection 3D image. Drainage lymphatic vessels (long arrows) from peritumoral and periareolar sites (arrowheads) appear to drain into two axillary SLNs at level I (short arrows). Different angle views of the surface-rendered and maximum intensity projection 3D images clearly show that lymphatic vessels drain into two axillary SLNs. Keys are the same as for Figure 1.
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Figure 2b. Patient 7. Images in a patient with 12 x 11-mm breast tumor in the right lower outer quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. Top left: Maximum intensity projection 3D image. Bottom left: Surface-rendered image. Right: Maximum intensity projection 3D image. Drainage lymphatic vessels (long arrows) from peritumoral and periareolar sites (arrowheads) appear to drain into two axillary SLNs at level I (short arrows). Different angle views of the surface-rendered and maximum intensity projection 3D images clearly show that lymphatic vessels drain into two axillary SLNs. Keys are the same as for Figure 1.
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Figure 3a. Patient 9. Images in a patient with 16 x 14-mm breast tumor in the right upper inner quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. Although drainage lymphatic vessels (long arrows) from the periareolar site (arrowhead P) drain into the axillary SLN at level I (short arrows), those from the peritumoral site (arrowhead T) drain into the parasternal SLN (short arrows). Different angle views of the maximum intensity projection 3D CT images clearly show the lymphatic vessels draining into the axillary and parasternal areas (long arrows). Keys are the same as for Figure 1.
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Figure 3b. Patient 9. Images in a patient with 16 x 14-mm breast tumor in the right upper inner quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. Although drainage lymphatic vessels (long arrows) from the periareolar site (arrowhead P) drain into the axillary SLN at level I (short arrows), those from the peritumoral site (arrowhead T) drain into the parasternal SLN (short arrows). Different angle views of the maximum intensity projection 3D CT images clearly show the lymphatic vessels draining into the axillary and parasternal areas (long arrows). Keys are the same as for Figure 1.
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Figure 4a. Patient 17. Images in a patient with 35 x 34-mm breast tumor in right upper outer quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. These images show that drainage lymphatic vessels (long arrows) from peritumoral and periareolar sites (arrowheads) drain into a single axillary SLN at level I (short arrow); however, this SLN (*) is not enhanced. Instead, the subsequent distant node was enhanced (curved arrow). In this case, the histologic findings of this SLN revealed marked tumoral infiltration. Keys are the same as for Figure 1.
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Figure 4b. Patient 17. Images in a patient with 35 x 34-mm breast tumor in right upper outer quadrant. (a) Transverse first postcontrast CT images. (b) Corresponding 3D CT lymphographic images. These images show that drainage lymphatic vessels (long arrows) from peritumoral and periareolar sites (arrowheads) drain into a single axillary SLN at level I (short arrow); however, this SLN (*) is not enhanced. Instead, the subsequent distant node was enhanced (curved arrow). In this case, the histologic findings of this SLN revealed marked tumoral infiltration. Keys are the same as for Figure 1.
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Copyright © 2004 by the Radiological Society of North America.
