CT淋巴造影技术在乳腺癌前哨淋巴结中的应用

doi:10.3969/j.issn.1674-490X.2023.02.006

摘要/Abstract

摘要： 前哨淋巴结(sentinel lymph node, SLN)在乳腺癌腋窝淋巴结诊疗过程起着至关重要的作用。前哨淋巴结活检(sentinel lymph node biopsy, SLNB)是诊断SLN是否存在转移的重要手段,也是决定乳腺癌患者是否进行腋窝淋巴结清扫(axillary lymph node dissection, ALND)的关键。随着医学技术的进步,影像造影技术也应用于SLN中。CT淋巴造影技术(computed tomography lymphography, CTLG)在SLN定位、检测以及SLNB中的应用得到临床工作者的重视,并对其在临床中的作用进行研究讨论。

关键词: 乳腺癌, 前哨淋巴结, 前哨淋巴结定位, 前哨淋巴结检测, 前哨淋巴结活检, CT淋巴造影技术

Abstract: Sentinel lymph nodes(SLN)play a vital role in the diagnosis and treatment of axillary lymph nodes in breast cancer. Sentinel lymph node biopsy(SLNB)is an important means to diagnose SLN metastasis, and it is also the key to determine whether axillary lymph node dissection(ALND)is performed in patients with breast cancer. With the development of medical technology, imaging technology is also applied to SLN. The application of computed tomography lymphography(CTLG)in SLN localization, detection and SLNB has been paid more and more attention by clinicians, and its role in clinical practice is discussed.

Key words: breast cancer, sentinel lymph node, sentinel lymph node localization, sentinel lymph node detection, sentinel lymph node biopsy, CT lymphography

中图分类号:

陈乾,李中. CT淋巴造影技术在乳腺癌前哨淋巴结中的应用[J]. 医学研究与教育, 2023, 40(2): 39-43.

参考文献

[1] SIEGEL R L, MILLER K D, FUCHS H E, et al. Cancer statistics, 2021[J]. CA A Cancer J Clin, 2021, 71(1): 7-33. DOI: 10.3322/caac.21654.
[2] GARCIA-ETIENNE C A, FERRARI A, DELLA VALLE A, et al. Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: an evidence-based update in a European breast center[J]. Eur J Surg Oncol, 2020, 46(1): 15-23. DOI: 10.1016/j.ejso.2019.08.013.
[3] VOINEA S C, SANDRU A, BORDEA C I, et al. A better understanding of axillary lymph node dissection in the era of sentinel lymph node biopsy[J]. Chirurgia(Bucur), 2021, 116(2): 162-169. DOI: 10.21614/chirurgia.116.2.162.
[4] 刘磊,李国政,张蕾,等.1个前哨淋巴结阳性乳腺癌患者的腋窝非前哨淋巴结转移情况及危险因素分析[J].中国肿瘤外科杂志, 2022, 14(1): 22-26. DOI: 10.3969/j.issn.1674-4136.2022.01.005.
[5] VÁZQUEZ J C, PIÑERO A, DE CASTRO F J, et al. The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview[J]. Clin Transl Oncol, 2022, 24(9): 1744-1754. DOI: 10.1007/s12094-022-02824-9.
[6] QIU S Q, ZHANG G J, JANSEN L, et al. Evolution in sentinel lymph node biopsy in breast cancer[J]. Crit Rev Oncol Hematol, 2018, 123: 83-94. DOI: 10.1016/j.critrevonc.2017.09.010.
[7] SUGA K, YUAN Y, OKADA M, et al. Breast sentinel lymph node mapping at CT lymphography with iopamidol: preliminary experience[J]. Radiology, 2004, 230(2): 543-552. DOI: 10.1148/radiol.2302021380.
[8] SUGA K, OGASAWARA N, OKADA M, et al. Interstitial CT lymphography-guided localization of breast sentinel lymph node: preliminary results[J]. Surgery, 2003, 133(2): 170-179. DOI: 10.1067/msy.2003.17.
[9] WANG B Y, OU C F, YU J G, et al. Three-dimensional visual technique based on CT lymphography data combined with methylene blue in endoscopic sentinel lymph node biopsy for breast cancer[J]. Eur J Med Res, 2022, 27(1): 274. DOI: 10.1186/s40001-022-00909-3.
[10] 马小开,郭飞,朱金海,等.CT三维重建在评估乳腺癌前哨淋巴结状态及其引流通路中的应用研究[J].天津医药, 2022, 50(3): 291-295. DOI: 10.11958/20212150.
[11] MINOHATA J, TAKAO S, HIROKAGA K. Sentinel lymph node biopsy using CT lymphography in breast cancer[J]. Breast Cancer, 2011, 18(2): 129-136. DOI: 10.1007/s12282-009-0183-z.
[12] WEN S S, LIANG Y R, KONG X L, et al. Application of preoperative computed tomographic lymphography for precise sentinel lymph node biopsy in breast cancer patients[J]. BMC Surg, 2021, 21(1): 187. DOI: 10.1186/s12893-021-01190-7.
[13] YAMAMOTO S, SUGA K, MAEDA K, et al. Breast sentinel lymph node navigation with three-dimensional computed tomography-lymphography: a 12-year study[J]. Breast Cancer, 2016, 23(3): 456-462. DOI: 10.1007/s12282-015-0584-0.
[14] ASHIBA H, NAKAYAMA R. Computerized evaluation scheme to detect metastasis in sentinel lymph nodes using contrast-enhanced computed tomography before breast cancer surgery[J]. Radiol Phys Technol, 2019, 12(1): 55-60. DOI: 10.1007/s12194-018-00491-6.
[15] OU X C, ZHU J B, QU Y M, et al. Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis[J]. BMC Med Imaging, 2021, 21(1): 193. DOI: 10.1186/s12880-021-00722-0.
[16] 黄雨.CT淋巴造影定位和亚甲蓝、吲哚菁绿双示踪在荧光腔镜前哨淋巴结活检中的应用[D].广州: 南方医科大学, 2021:24.
[17] SUGA K, YAMAMOTO S, TANGOKU A, et al. Breast sentinel lymph node navigation with three-dimensional interstitial multidetector-row computed tomographic lymphography[J]. Invest Radiol, 2005, 40(6): 336-342. DOI: 10.1097/01.rli.0000164153.41638.32.
[18] YAMAMOTO S, MAEDA N, YOSHIMURA K, et al. Intraoperative detection of sentinel lymph nodes in breast cancer patients using ultrasonography-guided direct indocyanine green dye-marking by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography[J]. Breast, 2013, 22(5): 933-937. DOI: 10.1016/j.breast.2013.05.001.
[19] MOKHTAR M, TADOKORO Y, NAKAGAWA M, et al. Triple assessment of sentinel lymph node metastasis in early breast cancer using preoperative CTLG, intraoperative fluorescence navigation and OSNA[J]. Breast Cancer, 2016, 23(2): 202-210. DOI: 10.1007/s12282-014-0551-1.
[20] HAMDY O, EL-BADRAWY A, SALEH G A, et al. Preoperative localization of sentinel lymph node in breast cancer patients by silver wire insertion or liquid charcoal injection guided by CT lymphography[J]. Breast J, 2020, 26(4): 617-624. DOI: 10.1111/tbj.13511.
[21] SUGIYAMA S, IWAI T, IZUMI T, et al. CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer[J]. Cancer Imaging, 2019, 19(1): 72. DOI: 10.1186/s40644-019-0258-9.
[22] KAMATA A, MIYAMAE T, KOIZUMI M, et al. Using computed tomography lymphography for mapping of sentinel lymph nodes in patients with breast cancer[J]. J Clin Imaging Sci, 2021, 14(11): 43-48. DOI: 10.25259/JCIS_33_2021.
[23] 袁南贵,罗雪平,胡玉萍,等.CT淋巴造影定位早期乳腺癌前哨淋巴结的安全性和疗效评估[J].中国处方药, 2021, 19(3): 164-165. DOI: 10.3969/j.issn.1671-945X.2021.03.087.
[24] 谭红娜,杨犇龙,王升平,等.乳腺癌前哨淋巴结CT淋巴管造影的可行性分析[J].中华放射学杂志, 2010, 44(5): 473-478. DOI: 10.3760/cma.j.issn.1005-1201.2010.05.006.
[25] 王攀鸽,谭红娜,王博,等.CT淋巴管造影在定位及评估早期乳腺癌前哨淋巴结中的应用价值[J].中华医学杂志, 2017, 97(35): 2762-2765. DOI: 10.3760/cma.j.issn.0376-2491.2017.35.011.
[26] NAKAGAWA M, MORIMOTO M, TAKECHI H, et al. Preoperative diagnosis of sentinel lymph node(SLN)metastasis using 3D CT lymphography(CTLG)[J]. Breast Cancer, 2016, 23(3): 519-524. DOI: 10.1007/s12282-015-0597-8.
[27] YANG X J, WU L, YE W T, et al. Deep learning signature based on staging CT for preoperative prediction of sentinel lymph node metastasis in breast cancer[J]. Acad Radio, 2020, 27(9): 1226-1233. DOI: 10.1016/j.acra.2019.11.007.
[28] MAO N, YIN P, LI Q, et al. Radiomics nomogram of contrast-enhanced spectral mammography for prediction of axillary lymph node metastasis in breast cancer: a multicenter study[J]. Eur Radiol, 2020, 30(12): 6732-6739. DOI: 10.1007/s00330-020-07016-z.
[29] YAMASHITA K, SHIMIZU K. Video-assisted breast surgery and sentinel lymph node biopsy guided by three-dimensional computed tomographic lymphography[J]. Surg Endosc, 2008, 22(2): 392-397. DOI: 10.1007/s00464-007-9407-5.
[30] FUJITA T, MIURA H, SEINO H, et al. Anatomical classification of breast sentinel lymph nodes using computed tomography-lymphography[J]. Anat Sci Int, 2018, 93(4): 487-494. DOI: 10.1007/s12565-018-0441-2.
[31] 黄雷, 余晋刚,叶建平,等.CT淋巴造影联合三维可视技术在乳腺癌淋巴回流路径研究中的应用[J].实用医学杂志, 2021, 37(14): 1861-1865.
[32] HASHIMOTO N, KUDO Y, KURUSHIMA M, et al. Computed tomographic lymphography for sentinel lymph node biopsy in male breast cancer: report of two cases[J]. Springerplus, 2013, 2: 351. DOI: 10.1186/2193-1801-2-351.
[32] MOTOMURA K, ISHITOBI M, KOMOIKE Y, et al. SPIO-enhanced magnetic resonance imaging for the detection of metastases in sentinel nodes localized by computed tomography lymphography in patients with breast cancer[J]. Ann Surg Oncol, 2011, 18(12): 3422-3429. DOI: 10.1245/s10434-011-1710-7.
[33] MOTOMURA K. Sentinel node biopsy for breast cancer: past, present, and future[J]. Breast Cancer, 2015, 22(3): 212-220. DOI: 10.1007/s12282-012-0421-7.