1
|
Banerjee P, Roy S, Chakraborty S. Recent advancement of imaging strategies of the lymphatic system: Answer to the decades old questions. Microcirculation 2022; 29:e12780. [PMID: 35972391 DOI: 10.1111/micc.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
The role of the lymphatic system in maintaining tissue homeostasis and a number of different pathophysiological conditions has been well established. The complex and delicate structure of the lymphatics along with the limitations of conventional imaging techniques make lymphatic imaging particularly difficult. Thus, in-depth high-resolution imaging of lymphatic system is key to understanding the progression of lymphatic diseases and cancer metastases and would greatly benefit clinical decisions. In recent years, the advancement of imaging technologies and development of new tracers suitable for clinical applications has enabled imaging of the lymphatic system in both clinical and pre-clinical settings. In this current review, we have highlighted the advantages and disadvantages of different modern techniques such as near infra-red spectroscopy (NIRS), positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI) and fluorescence optical imaging, that has significantly impacted research in this field and has led to in-depth insights into progression of pathological states. This review also highlights the use of current imaging technologies, and tracers specific for immune cell markers to identify and track the immune cells in the lymphatic system that would help understand disease progression and remission in immune therapy regimen.
Collapse
Affiliation(s)
- Priyanka Banerjee
- Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA
| | - Sukanya Roy
- Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA
| | - Sanjukta Chakraborty
- Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA
| |
Collapse
|
2
|
Chang YW, Lee HY, Lee CM, Jung SP, Kim WY, Woo SU, Lee JB, Son GS. Sentinel lymph node detection using fluorescein and blue light-emitting diodes in patients with breast carcinoma: A single-center prospective study. Asian J Surg 2020; 43:220-226. [DOI: 10.1016/j.asjsur.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/02/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
|
3
|
Akai H, Shiraishi K, Yokoyama M, Yasaka K, Nojima M, Inoue Y, Abe O, Ohtomo K, Kiryu S. PEG-poly(L-lysine)-based polymeric micelle MRI contrast agent: Feasibility study of a Gd-micelle contrast agent for MR lymphography. J Magn Reson Imaging 2017; 47:238-245. [DOI: 10.1002/jmri.25740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/04/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Hiroyuki Akai
- Department of Radiology; Institute of Medical Science, University of Tokyo; Tokyo Japan
| | - Kouichi Shiraishi
- Medical Engineering Laboratory; Research Center for Medical Science, Jikei University School of Medicine; Tokyo Japan
| | - Masayuki Yokoyama
- Medical Engineering Laboratory; Research Center for Medical Science, Jikei University School of Medicine; Tokyo Japan
| | - Koichiro Yasaka
- Department of Radiology; Institute of Medical Science, University of Tokyo; Tokyo Japan
| | - Masanori Nojima
- Division of Advanced Medicine Promotion; Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo; Tokyo Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology; Kitasato University School of Medicine; Kanagawa Japan
| | - Osamu Abe
- Department of Radiology; Graduate School of Medicine, University of Tokyo; Tokyo Japan
| | - Kuni Ohtomo
- International University of Health and Welfare; Tochigi Japan
| | - Shigeru Kiryu
- Department of Radiology; Institute of Medical Science, University of Tokyo; Tokyo Japan
| |
Collapse
|
4
|
Kang J, Chang JH, Kim SM, Lee HJ, Kim H, Wilson BC, Song TK. Real-time sentinel lymph node biopsy guidance using combined ultrasound, photoacoustic, fluorescence imaging: in vivo proof-of-principle and validation with nodal obstruction. Sci Rep 2017; 7:45008. [PMID: 28327582 PMCID: PMC5361205 DOI: 10.1038/srep45008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/20/2017] [Indexed: 12/20/2022] Open
Abstract
Precise sentinel lymph node (SLN) identification is crucial not only for accurate diagnosis of micro-metastases at an early stage of cancer progression but also for reducing the number of SLN biopsies (SLNB) to minimize their severe side effects. Furthermore, it is desirable that an SLNB guidance should be as safe as possible in routine clinical use. Although there are currently various SLNB guidance methods for pre-operative or intra-operative assessment, none are ideal. We propose a real-time SLNB guidance method using contrast-enhanced tri-modal images (i.e., ultrasound, photoacoustic, and fluorescence) acquired by a recently developed hand-held tri-modal probe. The major advantage of tri-modal imaging is demonstrated here through an in vivo study of the technically-difficult case of nodal obstruction that frequently leads to false-negative results in patients. The results in a tumor model in rabbits and normal controls showed that tri-modal imaging is capable of clearly identifying obstructed SLNs and of indicating their metastatic involvement. Based on these findings, we propose an SLNB protocol to help surgeons take full advantage of the complementary information obtained from tri-modal imaging, including for pre-operative localization, intra-operative biopsy guidance and post-operative analysis.
Collapse
Affiliation(s)
- Jeeun Kang
- Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea
| | - Jin Ho Chang
- Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea.,Sogang Institute of Advanced Technology, Sogang University, Seoul, 04107, South Korea.,Department of Biomedical Engineering, Sogang University, Seoul, 04107, South Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University of Bundang Hospital, Kyeonggi-do, 13620, South Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University of Bundang Hospital, Kyeonggi-do, 13620, South Korea
| | - Haemin Kim
- Department of Biomedical Engineering, Sogang University, Seoul, 04107, South Korea
| | - Brian C Wilson
- Princess Margaret Cancer Centre, University Health Network, M5G 1L7, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Ontario M5G 1L7, Canada
| | - Tai-Kyong Song
- Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea
| |
Collapse
|
5
|
Zhou W, Zhao Y, Pan H, Li Q, Li X, Chen L, Zha X, Ding Q, Wang C, Liu X, Wang S. Great tumour burden in the axilla may influence lymphatic drainage in breast cancer patients. Breast Cancer Res Treat 2016; 157:503-10. [DOI: 10.1007/s10549-016-3831-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
|
6
|
Boone J, Hobbelink MGG, Schipper MEI, Vleggaar FP, Borel Rinkes IHM, de Haas RJ, Ruurda JP, van Hillegersberg R. Sentinel node biopsy during thoracolaparoscopic esophagectomy for advanced esophageal cancer. World J Surg Oncol 2016; 14:117. [PMID: 27094390 PMCID: PMC4837514 DOI: 10.1186/s12957-016-0866-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/12/2016] [Indexed: 02/01/2023] Open
Abstract
Background Omitting extensive lymph node dissection could reduce esophagectomy morbidity in patients without lymph node metastases. Sentinel node biopsy may identify abdominal or thoracic lymph node metastases, thereby differentiating treatment. Feasibility of this approach was investigated in Western European esophageal cancer patients with advanced disease, without lymph node metastases at diagnostic work-up. Methods The sentinel node biopsy was performed in eight esophageal cancer patients with cT1-3N0 disease. One day pre-operatively, Tc-99m-labeled nanocolloid was endoscopically injected around the tumor. Lymphoscintigraphy was performed 1 and 3 h after injection. All patients underwent robotic thoracolaparoscopic esophagectomy with two-field lymph node dissection. Intraoperatively, sentinel nodes were detected by gamma probe. The resection specimen was analyzed for remaining activity by scintigraphy and gamma probe. Results Visualization rates of lymphoscintigraphy 1 and 3 h after tracer injection were 88 and 100 %, respectively. Intraoperative identification rate was 38 %. Postoperative identification was possible in all patients using the gamma probe to analyze the resection specimen. In 5/8 patients, lymph node metastases were found at histopathology, none of which was detected by the sentinel node biopsy. No adverse events related to the sentinel node biopsy were observed. Conclusions In our advanced esophageal cancer patients who underwent thoracolaparoscopic esophagectomy, the sentinel node biopsy did not predict lymph node status. Probably the real sentinel node could not be identified due to localization adjacent to the primary tumor or bypassing due to metastatic tumor involvement. Therefore, we consider the sentinel node biopsy not feasible in advanced esophageal cancer.
Collapse
Affiliation(s)
- Judith Boone
- Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Monique G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marguerite E I Schipper
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Robbert J de Haas
- Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery (G04.228), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| |
Collapse
|
7
|
Brissot HN, Edery EG. Use of indirect lymphography to identify sentinel lymph node in dogs: a pilot study in 30 tumours. Vet Comp Oncol 2016; 15:740-753. [DOI: 10.1111/vco.12214] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/20/2015] [Accepted: 12/20/2015] [Indexed: 12/24/2022]
Affiliation(s)
- H. N. Brissot
- Department of small animal surgery (Brissot) and internal medicine (Edery); Pride Veterinary Centre; Derby UK
| | - E. G. Edery
- Department of small animal surgery (Brissot) and internal medicine (Edery); Pride Veterinary Centre; Derby UK
| |
Collapse
|
8
|
KONDO R, FUJITA T, NISHIMURA H, KAMEDA N, FUJIMORI M. Comparison of 3D-CT Lymphography Images before and after Neoadjuvant Chemotherapy for Breast Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.3919/jjsa.77.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ryoichi KONDO
- Department of Surgery, Koyama Memorial Hospital
- Department of Breast Surgery, Tokyo Medical University Ibaraki Medical Center
| | - Tomoyuki FUJITA
- Department of Breast Surgery, Tokyo Medical University Ibaraki Medical Center
| | - Hajime NISHIMURA
- Department of Breast Surgery, Tokyo Medical University Ibaraki Medical Center
| | | | - Minoru FUJIMORI
- Department of Breast Surgery, Tokyo Medical University Ibaraki Medical Center
| |
Collapse
|
9
|
The Value of Isosulfan Blue Dye in Addition to Isotope Scanning in the Identification of the Sentinel Lymph Node in Breast Cancer Patients With a Positive Lymphoscintigraphy. Ann Surg 2015; 262:243-8. [DOI: 10.1097/sla.0000000000001213] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
10
|
Real-time lymphography by indocyanine green fluorescence: improved navigation for regional lymph node staging. Ann Plast Surg 2015; 73:701-5. [PMID: 23782892 DOI: 10.1097/sap.0b013e3182858831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lymphatic imaging is an important step for the identification of lymphonodal positive disease in solid malignancies. Various methods have been established to detect positive lymph nodes, but the available diagnostic tools leave some inherent drawbacks. The aim of this study was to validate the indocyanine green (ICG) guided approach for transcutaneous and transmesenterial navigation with accurate lymph vessel and node identification for regional lymph node staging in solid malignancies. METHODS After institutional review board approval, a planar fluorescence imaging system was applied for lymphography and lymph node detection using ICG. A total of 96 patients were recruited and subject to fluorescence navigation for axillary (n = 46), inguinal (n = 16), and mesenterial (n = 34) visualization to analyze technical and clinical feasibility of the method after regional lymph node dissection and the applicability. RESULTS Overall fluorescence imaging identified lymphatic vessels and the SLN in 92 out of 96 patients (detection rate: 96%) after a mean injection of 7 mg ICG. Sensitivity based on fluorescent emission of ICG navigation was 95.6% in 65 out of 68 patients with lymph node dissection. All solid tumors were feasible for fluorescence-guided navigation with a broad spectrum. CONCLUSION Fluorescence-guided real-time lymphography with navigation to regional lymph nodes enables accurate visualization for a broad spectrum of different solid tumors with potential lymphonodal spread. In addition, the technique can be applied for lymphography in non-malignant diseases. With reference to the broad application spectrum, institutional investment in camera equipment can be justified.
Collapse
|
11
|
Santanelli di Pompeo F, Laporta R, Longo B, Sorotos M, Papa A. Lymphatic drainage study after latissimus dorsi flap breast reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
Mokhtar M, Tadokoro Y, Nakagawa M, Morimoto M, Takechi H, Kondo K, Tangoku A. Triple assessment of sentinel lymph node metastasis in early breast cancer using preoperative CTLG, intraoperative fluorescence navigation and OSNA. Breast Cancer 2014; 23:202-10. [PMID: 25069434 DOI: 10.1007/s12282-014-0551-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) became a standard surgical procedure for patients with early breast cancer; however, the optimal method of sentinel lymph node (SLN) identification remains controversial. The current study presents the protocol of our institution for preoperative and intraoperative SLN detection. METHODS Fifty female patients with early breast cancer and clinically node-negative axilla were enrolled in this study. All patients underwent preoperative CT lymphography (CTLG), intraoperative SLNB using fluorescence navigation, intraoperative one-step nucleic acid amplification (OSNA) and postoperative hematoxylin and eosin histopathological analysis. Prediction of metastasis by CTLG and detection of metastasis by OSNA were compared to results of histopathology as standard reference. RESULTS SLN were identified by preoperative CTLG and intraoperative SLNB with fluorescence navigation in all patients, the identification rate was 100 %. SLN metastases were detected as positive by OSNA in 9 patients (18 %), 4 were (++), 4 were (+) and 1 was (+I). SLN metastases were detected as positive by histopathology in 10 patients (20 %). The concordance rate between OSNA and permanent sections was 90 %. The negative predictive value of CTLG was 80 %. CONCLUSION Use of CTLG and fluorescence navigation made performing SLNB with high accuracy possible in institutions that cannot use the radioisotope method. OSNA provided accurate intraoperative method, allowing for completion of axillary node dissection during surgery and avoidance of second surgical procedure in patients with positive SLNs, thereby reducing patient distress and, finally, saving hospital costs.
Collapse
Affiliation(s)
- Mohamed Mokhtar
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan.,Department of Oncological Surgery, Minia Oncology Institute, Minya, 61111, Egypt
| | - Yukiko Tadokoro
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan.
| | - Misako Nakagawa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Masami Morimoto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Hirokazu Takechi
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| |
Collapse
|
13
|
Murtaza G, Gao K, Liu T, Tariq I, Sajjad A, Akram MR, Niu M, Liu G, Mehmood Z, Tian G. Current and future lymphatic imaging modalities for tumor staging. BIOMED RESEARCH INTERNATIONAL 2014; 2014:714674. [PMID: 24757671 PMCID: PMC3976799 DOI: 10.1155/2014/714674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
Tumor progression is supported by the lymphatic system which should be scanned efficiently for tumor staging as well as the enhanced therapeutic outcomes. Poor resolution and low sensitivity is a limitation of traditional lymphatic imaging modalities; thus new noninvasive approaches like nanocarriers, magnetic resonance imaging, positron-emission tomography, and quantum dots are advantageous. Some newer modalities, which are under development, and their potential uses will also be discussed in this review.
Collapse
Affiliation(s)
- Ghulam Murtaza
- Department of Pharmacy, COMSATS Institute of Information Technology, Abbottabad 22060, Pakistan
| | - Kuo Gao
- Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chao Yang District, Beijing 100029, China
| | - Tiegang Liu
- Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chao Yang District, Beijing 100029, China
| | - Imran Tariq
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Ashif Sajjad
- Institute of Biochemistry, University of Balochistan, Quetta 87300, Pakistan
| | | | - Meiying Niu
- Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chao Yang District, Beijing 100029, China
| | - Guokai Liu
- Beijing University of Chinese Medicine, Dongzhimen Hospital, Dong Cheng District, Beijing 100700, China
| | - Zahid Mehmood
- Institute of Biochemistry, University of Balochistan, Quetta 87300, Pakistan
| | - Guihua Tian
- Beijing University of Chinese Medicine, Dongzhimen Hospital, Dong Cheng District, Beijing 100700, China
| |
Collapse
|
14
|
Sevick-Muraca EM, Kwon S, Rasmussen JC. Emerging lymphatic imaging technologies for mouse and man. J Clin Invest 2014; 124:905-14. [PMID: 24590275 DOI: 10.1172/jci71612] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The lymphatic circulatory system has diverse functions in lipid absorption, fluid homeostasis, and immune surveillance and responds dynamically when presented with infection, inflammation, altered hemodynamics, and cancer. Visualization of these dynamic processes in human disease and animal models of disease is key to understanding the contributory role of the lymphatic circulatory system in disease and to devising effective therapeutic strategies. Longitudinal, non-destructive, and repeated imaging is necessary to expand our understanding of disease progression and regression in basic science and clinical investigations. Herein we summarize recent advances in in vivo lymphatic imaging employing magnetic resonance, computed tomography, lymphoscintigraphy, and emerging optical techniques with respect to their contributory roles in both basic science and clinical research investigations.
Collapse
|
15
|
Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature. Breast Cancer Res Treat 2014; 144:213-22. [DOI: 10.1007/s10549-014-2866-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
|
16
|
Lee YJ, Kim YH, Lee KH, Park JH, Lee HS, Jung SC, Joo SM. Sentinel node mapping of VX2 carcinoma in rabbit thigh with CT lymphography using ethiodized oil. Korean J Radiol 2014; 15:29-36. [PMID: 24497789 PMCID: PMC3909858 DOI: 10.3348/kjr.2014.15.1.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/13/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. MATERIALS AND METHODS This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. RESULTS All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean ± standard deviation, 1.7 ± 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. CONCLUSION Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.
Collapse
Affiliation(s)
- Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Seung Chai Jung
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Seung-Moon Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| |
Collapse
|
17
|
Motomura K, Sumino H, Noguchi A, Horinouchi T, Nakanishi K. Sentinel nodes identified by computed tomography-lymphography accurately stage the axilla in patients with breast cancer. BMC Med Imaging 2013; 13:42. [PMID: 24321242 PMCID: PMC4028847 DOI: 10.1186/1471-2342-13-42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 12/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sentinel node biopsy often results in the identification and removal of multiple nodes as sentinel nodes, although most of these nodes could be non-sentinel nodes. This study investigated whether computed tomography-lymphography (CT-LG) can distinguish sentinel nodes from non-sentinel nodes and whether sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. METHODS This study included 184 patients with breast cancer and clinically negative nodes. Contrast agent was injected interstitially. The location of sentinel nodes was marked on the skin surface using a CT laser light navigator system. Lymph nodes located just under the marks were first removed as sentinel nodes. Then, all dyed nodes or all hot nodes were removed. RESULTS The mean number of sentinel nodes identified by CT-LG was significantly lower than that of dyed and/or hot nodes removed (1.1 vs 1.8, p <0.0001). Twenty-three (12.5%) patients had ≥2 sentinel nodes identified by CT-LG removed, whereas 94 (51.1%) of patients had ≥2 dyed and/or hot nodes removed (p <0.0001). Pathological evaluation demonstrated that 47 (25.5%) of 184 patients had metastasis to at least one node. All 47 patients demonstrated metastases to at least one of the sentinel nodes identified by CT-LG. CONCLUSIONS CT-LG can distinguish sentinel nodes from non-sentinel nodes, and sentinel nodes identified by CT-LG can accurately stage the axilla in patients with breast cancer. Successful identification of sentinel nodes using CT-LG may facilitate image-based diagnosis of metastasis, possibly leading to the omission of sentinel node biopsy.
Collapse
Affiliation(s)
- Kazuyoshi Motomura
- Departments of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku 537-8511Osaka, Japan.
| | | | | | | | | |
Collapse
|
18
|
Nakajima T, Turkbey B, Sano K, Sato K, Bernardo M, Hoyt RF, Choyke PL, Kobayashi H. MR lymphangiography with intradermal gadofosveset and human serum albumin in mice and primates. J Magn Reson Imaging 2013; 40:691-7. [PMID: 24123370 DOI: 10.1002/jmri.24395] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/15/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate MR lymphangiography in mice and primates with intradermal Gadofosveset and human serum albumin. Gadofosveset is a US FDA approved small molecule Gadolinium (Gd) chelate (957 Da) which reversibly binds serum albumin and temporally behaves as a macromolecule. As the structure of albumin varies among species, the affinity of Gadofosveset is optimized for human albumin. In this study, Gadofosveset premixed with 10% human serum albumin (HSA) was injected intradermally in mice and monkeys, and then MR lymphangiography was performed on a 3.0 Tesla clinical scanner. MATERIALS AND METHODS Twenty microliters of each agent was injected intradermally at both sides of the front and back paws using a 30-gauge needle into female athymic nude mice (6-8 weeks old, n = 3 mice in each group). The performance of Gadofosveset-HSA was compared with Gd-labeled dendrimers (G4: 6 nm, G6: 10 nm) or Gd-DTPA. The target-to-muscle ratio (TMR = target signal intensity (SI)/muscle SI) was calculated at each time point. The TMRs were compared with a one-way analysis of variance followed by a Bonferroni multiple comparison test. RESULTS Images taken as early as 2.5 min after intradermal (id) injection depicted enhanced lymph nodes using Gadofosveset-HSA (2.41 ± 0.20). Up to 7.5 min after injection, TMRs of Gadofosveset-HSA were greater than those of dendrimers (G4 or G6-Gd-DTPA: 2.24 ± 0.10, 2.12 ± 0.11, respectively). By 15 min postinjection, TMRs of Gadofosveset-HSA (2.18 ± 0.19) were comparable to Gd-labeled dendrimers (G4-Gd-DTPA: 2.37 ± 0.15, G6-Gd-DTPA: 2.25 ± 0.18). Gadofosveset-HSA and Gd labeled dendrimers resulted in satisfactory MR lymphography in mice and monkeys. CONCLUSION Because both Gadofosveset and HSA are approved for human use and Gadofosveset clears rapidly through the kidneys, this method has advantages over Gd-dendrimers and could be used for visualizing lymphatic drainage and detecting lymph nodes.
Collapse
|
19
|
Lu Q, Hua J, Kassir MM, Delproposto Z, Dai Y, Sun J, Haacke M, Hu J. Imaging lymphatic system in breast cancer patients with magnetic resonance lymphangiography. PLoS One 2013; 8:e69701. [PMID: 23861979 PMCID: PMC3702586 DOI: 10.1371/journal.pone.0069701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/17/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the feasibility of gadolinium (Gd) contrast-enhanced magnetic resonance lymphangiography (MRL) in breast cancer patients within a typical clinical setting, and to establish a Gd-MRL protocol and identify potential MRL biomarkers for differentiating metastatic from non-metastatic lymph nodes. Materials and Methods 32 patients with unilateral breast cancer were enrolled and divided into 4 groups of 8 patients. Groups I, II, and III received 1.0, 0.5, and 0.3 ml of intradermal contrast; group IV received two 0.5 ml doses of intradermal contrast. MRL images were acquired on a 3.0 T system and evaluated independently by two radiologists for the number and size of enhancing lymph nodes, lymph node contrast uptake kinetics, lymph vessel size, and contrast enhancement patterns within lymph nodes. Results Group III patients had a statistically significant decrease in the total number of enhancing axillary lymph nodes and lymphatic vessels compared to all other groups. While group IV patients had a statistically significant faster time to reach the maximum peak enhancement over group I and II (by 3 minutes), there was no other statistically significant difference between imaging results between groups I, II, and IV. 27 out of 128 lymphatic vessels (21%) showed dilatation, and all patients with dilated lymphatic vessels were pathologically proven to have metastases. Using the pattern of enhancement defects as the sole criterion for identifying metastatic lymph nodes during Gd-MRL interpretation, and using histopathology as the gold standard, the sensitivity and specificity were estimated to be 86% and 95%, respectively. Conclusion Gd-MRL can adequately depict the lymphatic system, can define sentinel lymph nodes, and has the potential to differentiate between metastatic and non-metastatic lymph nodes in breast cancer patients.
Collapse
Affiliation(s)
- Qing Lu
- Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Hua
- Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (J. Hua); (J. Hu)
| | - Mohammad M. Kassir
- Department of Radiology, Wayne State University; Michigan, United States of America
| | - Zachary Delproposto
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Yongming Dai
- MR Business, Greater China, Philips Healthcare, Shanghai, China
| | - Jingyi Sun
- Department of Radiology, Wayne State University; Michigan, United States of America
| | - Mark Haacke
- Department of Radiology, Wayne State University; Michigan, United States of America
| | - Jiani Hu
- Department of Radiology, Wayne State University; Michigan, United States of America
- * E-mail: (J. Hua); (J. Hu)
| |
Collapse
|
20
|
Sun Y, Peng J, Feng W, Li F. Upconversion nanophosphors Naluf₄:Yb,Tm for lymphatic imaging in vivo by real-time upconversion luminescence imaging under ambient light and high-resolution X-ray CT. Am J Cancer Res 2013; 3:346-53. [PMID: 23650481 PMCID: PMC3645060 DOI: 10.7150/thno.5137] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/09/2012] [Indexed: 12/05/2022] Open
Abstract
Lanthanide upconversion nanophosphor (UCNP) has attracted increasing attention for potential applications in bioimaging due to its excellence in deep and high contrast imaging. To date, most upconversion imaging applications were demonstrated in dark surroundings without ambient light for higher signal-to-noise ratio, which hindered the application of optical imaging guided surgery. Herein, the new established NaLuF4-based UCNP (NaLuF4:Yb,Tm, ~17 nm) with bright upconversion emission around 800 nm as imaging signal was used to realize imaging under ambient light to provide more convenient for clinician. Moreover, due to the existance of heavy element lutetium (Lu) in the host lattice, the NaLuF4:Yb,Tm nanoparticles can also be used as an X-ray CT imaging agent to enhance the imaging depth and in vivo imaging resolution.
Collapse
|
21
|
Kim YH, Lee YJ, Park JH, Lee KH, Lee HS, Park YS, Park DJ, Kim HH. Early gastric cancer: feasibility of CT lymphography with ethiodized oil for sentinel node mapping. Radiology 2013; 267:414-21. [PMID: 23382288 DOI: 10.1148/radiol.12121527] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the feasibility of CT lymphography with ethiodized oil for sentinel node mapping in porcine stomachs and in patients with early gastric cancer. MATERIALS AND METHODS Approval for the animal study was obtained from the authors' institutional animal use and care administrative advisory committee, the clinical study was approved by the institutional review board, and informed consent was obtained from each participant. Five pigs underwent CT lymphography 1 hour after gastric subserosal injection of 1 mL ethiodized oil and sentinel node mapping with injection of 1 mL methylene blue. Ethiodized oil retention nodes were identified on the radiographic images of the gastric specimen and removed for histopathologic examination. In addition, 10 patients with early gastric cancer underwent CT lymphography with peritumoral injection of 1 mL ethiodized oil, followed by sentinel basin extirpation with CT and routine nodal dissection. The removed sentinel basins were examined by radiography. Histopathologic examination was performed for dissected nodes, including sentinel nodes. RESULTS In each of the five pigs, CT showed one perigastric ethiodized oil retention node. After harvesting the ethiodized oil retention node, blue-stained areas were identified in the five removed nodes and intranodal ethiodized oil was detected on histopathologic examination. In all 10 patients, CT lymphography with ethiodized oil successfully defined the sentinel basin with ethiodized oil retention nodes. CT lymphography revealed 20 ethiodized oil retention nodes. After basin extirpation, 28 and 46 nodes were detected on radiographic and histopathologic examinations. Histopathologic examination revealed that one patient had micrometastases at two sentinel nodes and another patient had isolated tumor cells at one sentinel node. No patient had metastasis in nonsentinel nodes. CONCLUSION CT lymphography with ethiodized oil may be a feasible method for sentinel node mapping in patients with early gastric cancer.
Collapse
Affiliation(s)
- Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kiryu S, Inoue Y, Sheng F, Watanabe M, Yoshikawa K, Shimada M, Ohtomo K. Interstitial MR lymphography in mice: comparative study with gadofluorine 8, gadofluorine M, and gadofluorine P. Magn Reson Med Sci 2012; 11:99-107. [PMID: 22790296 DOI: 10.2463/mrms.11.99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated the characteristics and capability of interstitial MR lymphography in mice using gadofluorine 8, gadofluorine M, and gadofluorine P. METHODS We injected healthy mice with 0.5 µmol of Gd gadofluorine 8, gadofluorine M, or gadofluorine P subcutaneously into the right rear footpad and assessed the time courses of contrast enhancement in the lymph nodes. Six mice were studied for each contrast agent. We also used gadofluorine M to assess the lymphatic pathway from the right and left rear feet or tail. RESULTS Contrast enhancement was demonstrated for the right popliteal, sacral, and iliac lymph nodes in all mice 5 minutes after injection of each of the 3 agents and decreased gradually. Enhancement in the lymph nodes was still detectable 30 minutes after injection of gadofluorine 8 or gadofluorine M. Enhancement became obscure sooner after gadofluorine P injection and was mildly stronger with the other 2 contrast agents. Clear differences were found in the hepatobiliary and urinary kinetics of the 3 agents. Gadofluorine M injected into various sites delineated the lymphatic pathway from the site of injection. CONCLUSION Interstitial MR lymphography using gadofluorine 8, gadofluorine M, and gadofluorine P offered clear visualization of the lymphatic pathway in healthy mice during a sufficient imaging time window, and allowed repeated assessment of the pathway and clarification of the lymphatic system.
Collapse
Affiliation(s)
- Shigeru Kiryu
- Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
23
|
Yokohata K, Hattori M, Fujimoto T, Chikazawa N, Maeyama R, Yamanaka N, Kuroki H, Sasaki N, Kameoka N, Matoba N. Computed tomographic lymphography predicts the difficulty of sentinel lymph node biopsy with dye. Breast Cancer 2012; 21:198-201. [DOI: 10.1007/s12282-012-0385-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 05/30/2012] [Indexed: 11/28/2022]
|
24
|
Sentinel Node Mapping with Thermoresponsive Magnetic Nanoparticles in Rats. J Surg Res 2012; 174:48-55. [DOI: 10.1016/j.jss.2010.11.884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 10/22/2010] [Accepted: 11/09/2010] [Indexed: 11/21/2022]
|
25
|
Saito M, Nishiyama H, Oda Y, Shingaki S, Hayashi T. The lingual lymph node identified as a sentinel node on CT lymphography in a patient with cN0 squamous cell carcinoma of the tongue. Dentomaxillofac Radiol 2011; 41:254-8. [PMID: 22074865 DOI: 10.1259/dmfr/61883763] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We performed CT lymphography on an 81-year-old female patient with a histologically confirmed squamous cell carcinoma of the tongue with no clinical or radiological evidence of cervical lymph node involvement. The lateral lingual lymph node was identified as a sentinel node, which is the first lymph node to receive drainage from a primary tumour. CT lymphography also showed draining lymphatics passing through the sublingual space, the medial side of the submandibular gland and near the hyoid bone and connected with the middle internal jugular node. Although metastasis to the lateral lingual lymph node is known as one of the crucial events in determining survival outcome in cancer of the tongue and floor of the mouth, very few reports are available on the imaging of the lateral lingual lymph node metastasis. This is the first report regarding the lateral lingual lymph node identified as a sentinel node demonstrated on CT lymphography.
Collapse
Affiliation(s)
- M Saito
- Division of Oral and Maxillofacial Radiology, Department of Tissue Regeneration and Reconstruction Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences, Chuou-ku, Niigata, Japan.
| | | | | | | | | |
Collapse
|
26
|
Abstract
Noninvasive in vivo imaging of lymphatic vessels and lymphatic nodes is expected to fulfill the purpose of analyzing lymphatic vessels and their function, understanding molecular mechanisms of lymphangiogenesis and lymphatic spread of tumors, and utilizing lymphatic molecular markers as a prognostic or diagnostic indicator. In this review, we provide a comprehensive summary of in vivo imaging modalities for detecting lymphatic vessels, lymphatic drainage, and lymphatic nodes, which include conventional lymphatic imaging techniques such as dyes and radionuclide scintigraphy as well as novel techniques for lymphatic imaging such as optical imaging, computed tomography, magnetic resonance imaging, ultrasound, positron emission tomography using lymphatic biomarkers, photoacoustic imaging, and combinations of multiple modalities. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve the research of lymphatic vascular system in health and disease states as well as to improve the accuracy of diagnosis in the relevant diseases.
Collapse
Affiliation(s)
- Fan Zhang
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | | | | | | |
Collapse
|
27
|
Sever AR, Mills P, Hyvelin JM, Weeks J, Gumus H, Fish D, Mali W, Jones SE, Jones PA, Devalia H. Percutaneous removal of sentinel lymph nodes in a swine model using a breast lesion excision system and contrast-enhanced ultrasound. Eur Radiol 2011; 22:545-50. [DOI: 10.1007/s00330-011-2293-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
|
28
|
Nune SK, Gunda P, Majeti BK, Thallapally PK, Forrest ML. Advances in lymphatic imaging and drug delivery. Adv Drug Deliv Rev 2011; 63:876-85. [PMID: 21718728 PMCID: PMC3164439 DOI: 10.1016/j.addr.2011.05.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 10/09/2010] [Accepted: 05/09/2011] [Indexed: 01/07/2023]
Abstract
Cancer remains the second leading cause of death after heart disease in the US. While metastasized cancers such as breast, prostate, and colon are incurable, before their distant spread, these diseases have invaded the lymphatic system as a first step in their progression. Hence, proper evaluation of the disease state of the lymphatics which drain a tumor site is crucial to staging and the formation of a treatment plan. Current lymphatic imaging modalities with visible dyes and radionucleotide tracers offer limited sensitivity and poor resolution; however, newer tools using nanocarriers, quantum dots, and magnetic resonance imaging promise to vastly improve the staging of lymphatic spread without needless biopsies. Concurrent with the improvement of lymphatic imaging agents, has been the development of drug carriers that can localize chemotherapy to the lymphatic system, thus improving the treatment of localized disease while minimizing the exposure of healthy organs to cytotoxic drugs. This review will focus on the use of various nanoparticulate and polymeric systems that have been developed for imaging and drug delivery to the lymph system, how these new devices improve upon current technologies, and where further improvement is needed.
Collapse
Affiliation(s)
- Satish K. Nune
- Energy and Environment Directorate, Pacific Northwest National Laboratory, Richland, Washington 99352
| | - Padmaja Gunda
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas 66045
| | - Bharat K. Majeti
- Moores UCSD Cancer Center, University of California, San Diego, CA, 92093-0803
| | - Praveen K. Thallapally
- Energy and Environment Directorate, Pacific Northwest National Laboratory, Richland, Washington 99352
| | - M. Laird Forrest
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas 66045
| |
Collapse
|
29
|
Localization and Evaluation of Sentinel Lymph Node in Breast Cancer From Computed Tomographic Lymphography. J Comput Assist Tomogr 2011; 35:367-74. [DOI: 10.1097/rct.0b013e318213ccd9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Kuroki-Suzuki S, Kuroki Y, Ishikawa T, Takeo H, Moriyama N. Diagnosis of breast cancer with multidetector computed tomography: analysis of optimal delay time after contrast media injection. Clin Imaging 2010; 34:14-9. [PMID: 20122514 DOI: 10.1016/j.clinimag.2009.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 02/19/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to investigate the optimal delay time after a contrast media injection for multidetector computed tomography (MD-CT) images in the diagnosis of breast cancer patients. MATERIALS AND METHODS Thirty-one patients who underwent MD-CT for their preoperative examination and who had postoperatively confirmed pathology were enrolled. Four-phase images of dynamic contrast enhanced study were acquired using four-detector MDCT. All cases were mammographically classified into two groups according to BI-RADS: nondense and dense groups. The CT value of the background mammary gland, background breast enhancement (BBE), and tumor-background mammary gland contrast (TBC) were compared between the two groups. RESULTS The CT value of the dense group was significantly higher than that of the nondense group in all phases. BBE in both nondense and dense groups showed no significant differences in any of the phases. In the nondense group, TBC was significantly higher in both the second and the third phases than in the first phase, while in the dense group, TBC was significantly higher in the second phase than in the first and third phases. CONCLUSION The optimal delay time to depict breast cancer is 80 s after a contrast media injection, regardless of the density level of the background mammary gland.
Collapse
Affiliation(s)
- Seiko Kuroki-Suzuki
- Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo 104-0045, Japan.
| | | | | | | | | |
Collapse
|
31
|
Ravizzini G, Turkbey B, Barrett T, Kobayashi H, Choyke PL. Nanoparticles in sentinel lymph node mapping. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2010; 1:610-23. [PMID: 20049820 DOI: 10.1002/wnan.48] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The lymph nodes and lymphatic vessels are more difficult to access than most vascular structures. Interstitial injection of imaging agents is often necessary to opacify the lymphatics. Traditionally, radionuclide methods of sentinel node imaging have dominated this field, however, limitations in resolution and exposure to radiation have encouraged the development of newer imaging methods. Among these are magnetic resonance lymphography in which a Gadolinium labeled nanoparticle is injected and imaged providing superior anatomic resolution and assessment of lymphatic dynamics. Optical imaging employing various nanoparticles including quantum dots also provide the capability of mapping each lymphatic basin in another "color". Taken together this "toolbox" of lymphatic imaging agents is poised to improve our understanding of the lymphatic system.
Collapse
Affiliation(s)
- Gregory Ravizzini
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | | | | |
Collapse
|
32
|
Feasibility of Interstitial CT Lymphography Using Optimized Iodized Oil Emulsion in Rats. Invest Radiol 2010; 45:142-8. [DOI: 10.1097/rli.0b013e3181c8cf19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
33
|
Sentinel lymph node biopsy using CT lymphography in breast cancer. Breast Cancer 2009; 18:129-36. [DOI: 10.1007/s12282-009-0183-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 09/29/2009] [Indexed: 10/24/2022]
|
34
|
Monzawa S, Adachi S, Suzuki K, Hirokaga K, Takao S, Sakuma T, Hanioka K. Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography of breast cancer in detecting axillary lymph node metastasis: comparison with ultrasonography and contrast-enhanced CT. Ann Nucl Med 2009; 23:855-61. [DOI: 10.1007/s12149-009-0314-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 09/20/2009] [Indexed: 11/28/2022]
|
35
|
Omoto K, Matsunaga H, Take N, Hozumi Y, Takehara M, Omoto Y, Shiozawa M, Mizunuma H, Harashima H, Taniguchi N, Kawano M. Sentinel node detection method using contrast-enhanced ultrasonography with sonazoid in breast cancer: preliminary clinical study. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1249-1256. [PMID: 19520493 DOI: 10.1016/j.ultrasmedbio.2009.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 01/31/2009] [Accepted: 02/10/2009] [Indexed: 05/27/2023]
Abstract
This study aimed to evaluate the usefulness of sentinel lymph node (SLN) detection in breast cancer using contrast-enhanced ultrasonography (CEUS) with subareolar Sonazoid injection. The subjects were 20 breast cancer patients. General anesthesia was induced and 2 mL of Sonazoid was injected subareolarly. After massage of the injection site, the axillary area was observed transdermally using coded phase inversion harmonic ultrasonography with mechanical indices of 0.15 to 0.19. When contrast-enhanced lymph nodes (LNs) were seen, they were defined as CE-SLN. Two other SLN detection methods, the gamma-probe-guided and dye-guided methods, were performed together. We evaluated the SLNs detected by each method to determine if they corresponded with each other and calculated the SLN detection rate. After the SLNs were resected, pathologic examinations were done. The SLN detection rate of the CEUS-guided method, the dye-guided method and the gamma-probe-guided method were 70%, 75% and 100%, respectively. There was no statistically significant difference in these rates between the CEUS-guided and dye-guided methods (p = 0.99) but the CEUS-guided method showed a significantly lower rate than the gamma-probe-guided method (p = 0.020), and dye-guided method also showed a significantly lower rate than the gamma-probe-guided method (p = 0.047). The number of CE-SLNs was 1 or 2 (average 1.1) and each took 2 to 20 (average 5.3) min to detect. The CE-SLNs corresponded grossly with SLNs detected by the gamma-probe-guided and dye-guided methods. The pathologic results indicated no metastasis from the resected SLNs in 15 of 20 cases. However, the CEUS-guided method detected 12 cases of these 15 and CE-SLNs were detected in two of the remaining five metastasis cases. In summary, in breast cancer patients, after subareolar injection of Sonazoid, contrast-enhanced LNs were observed in real time with ultrasonography. In an initial clinical study of 20 cases, the detection rate of the CEUS-guided method was less than that of the gamma-probe-guided method. It is suggested that the CEUS-guided method using Sonazoid may, with some improvements, be a useful new modality for sentinel node identification.
Collapse
Affiliation(s)
- Kiyoka Omoto
- Department of Laboratory Medicine, Diagnostic Ultrasound Division, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Pan WR, Rozen WM, Stella DL, Ashton MW. A Three-Dimensional Analysis of the Lymphatics of a Bilateral Breast Specimen: A Human Cadaveric Study. Clin Breast Cancer 2009; 9:86-91. [DOI: 10.3816/cbc.2009.n.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
37
|
JOHNSON ERICG, WISNER ERIKR, KYLES ANDREW, KOEHLER CARL, MARKS STANLEYL. Computed Tomographic Lymphography of the Thoracic Duct by Mesenteric Lymph Node Injection. Vet Surg 2009; 38:361-7. [DOI: 10.1111/j.1532-950x.2008.00473.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
38
|
Ogasawara Y, Ikeda H, Takahashi M, Kawasaki K, Doihara H. Evaluation of breast lymphatic pathways with indocyanine green fluorescence imaging in patients with breast cancer. World J Surg 2009; 32:1924-9. [PMID: 18330628 DOI: 10.1007/s00268-008-9519-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with early breast cancer, sentinel lymph node biopsy (SLNB) has been emerging as a new standard of care. The use of SLNB with a blue dye is convenient and safe, but it requires a high level of technical skill. Recently, an instrument that can provide fluorescence imaging of lymphatic flow has been introduced. In the present study, we analyzed breast lymphatic pathways and discussed its potential as a modality to complement the use of SLNB with a blue dye. METHODS Thirty-seven consecutive patients with breast cancer were examined. To obtain fluorescence imaging, an invisible near-infrared fluorescence imaging system was used. After indocyanine green was subdermally injected in the subareolar site and at two sites around the tumor, the subcutaneous lymphatic drainage pathway (LDP) was observed. RESULTS In 27 (72.9%) of the patients, the number of LDP from the periareolar area was one or two. In 21(63.6%) of 33 patients with subdermal injection around the tumor, no LDP was observed from the peritumoral area. Lymphatic connection between the peritumoral area and the periareolar area was observed very frequently (91.7%). In 26 (70.3%) of the patients, multiple routes joined together and only one route was ultimately directed to the axilla. Significant correlation was seen between body mass index (BMI) and the transit time to the axilla after injection (p = 0.0038). Additionally, a significant correlation was seen between the number of LPD from the periareolar area and the distance between detected SLNs and the fluorescence line-disappearing point (p = 0.034). CONCLUSIONS This instrument can provide some important information, and can be an available and reliable navigator for SLNB with a blue dye.
Collapse
Affiliation(s)
- Yutaka Ogasawara
- Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama-City, Okayama 700-8558, Japan.
| | | | | | | | | |
Collapse
|
39
|
Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol 2008; 19:561-9. [DOI: 10.1007/s00330-008-1177-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/05/2008] [Accepted: 08/24/2008] [Indexed: 02/05/2023]
|
40
|
Murgo S, Wyshoff H, Faverly D, Crener K, Lenaerts L. Computed Tomography-Guided Localization of Breast Lesions. Breast J 2008; 14:169-75. [DOI: 10.1111/j.1524-4741.2007.00549.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
41
|
Abe H, Schmidt RA, Sennett CA, Shimauchi A, Newstead GM. US-guided Core Needle Biopsy of Axillary Lymph Nodes in Patients with Breast Cancer: Why and How to Do It. Radiographics 2007; 27 Suppl 1:S91-9. [DOI: 10.1148/rg.27si075502] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
42
|
Tangoku A, Seike J, Nakano K, Nagao T, Honda J, Yoshida T, Yamai H, Matsuoka H, Uyama K, Goto M, Miyoshi T, Morimoto T. Current status of sentinel lymph node navigation surgery in breast and gastrointestinal tract. THE JOURNAL OF MEDICAL INVESTIGATION 2007; 54:1-18. [PMID: 17380009 DOI: 10.2152/jmi.54.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sentinel lymph node biopsy (SLNB) has been developed as a new diagnostic and therapeutic modality in melanoma and breast cancer surgery. The purpose of the SLNB include preventing the operative morbidity and improving the pathologic stage by focusing on fewer lymph nodes using immunocytochemic and molecular technology has almost achieved in breast cancer surgery. The prognostic meaning of immunocytochemically detected micrometastases is also evaluating in the SLN and bone marrow aspirates of women with early-stage breast cancer. SLNB using available techniques have suggested that the lymphatic drainage of the gastrointestinal tract is much more complicated than other sites, skip metastasis being rather frequent because of an aberrant lymphatic drainage outside of the basin exist. At the moment, the available data does not justify reduced extent of lymphadenectomy, but provides strong evidence for an improvement in tumor staging on the basis of SLNB. Two large scale prospective multi-center trials concerning feasibility of gamma-probe and dye detection for gastric cancer are ongoing in Japan. Recent studies have shown favorable results for identification of SLN in esophageal cancer. CT lymphography with endoscopic mucosal injection of iopamidol was applicable for SLN navigation of superficial esophageal cancer. The aim of surgical treatment is complete resection of the tumor-infiltrated organ including the regional lymph nodes. Accurate detection of SLN can achieve a selection of a more sophisticated tailor made approach. The patient can make a individualized choice from a broader spectrum of therapeutic options including endoscopic, laparoscopic or laparoscopy-assisted surgery, modified radical surgery, and typical radical surgery with lymph node dissection. Ultrastaging by detecting micrometastasis at the molecular level and the choice of an adequate treatment improve the postoperative quality of life and survival. However these issues require further investigation.
Collapse
Affiliation(s)
- Akira Tangoku
- Department of Oncological and Regenerative Surgery, Institute of Health Bioscience, The University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Barrett T, Choyke PL, Kobayashi H. Imaging of the lymphatic system: new horizons. CONTRAST MEDIA & MOLECULAR IMAGING 2007; 1:230-45. [PMID: 17191764 DOI: 10.1002/cmmi.116] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The lymphatic system is a complex network of lymph vessels, lymphatic organs and lymph nodes. Traditionally, imaging of the lymphatic system has been based on conventional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI), whereby enlargement of lymph nodes is considered the primary diagnostic criterion for disease. This is particularly true in oncology, where nodal enlargement can be indicative of nodal metastases or lymphoma. CT and MRI on their own are, however, anatomical imaging methods. Newer imaging methods such as positron emission tomography (PET), dynamic contrast-enhanced MRI (DCE-MRI) and color Doppler ultrasound (CDUS) provide a functional assessment of node status. None of these techniques is capable of detecting flow within the lymphatics and, thus, several intra-lymphatic imaging methods have been developed. Direct lymphangiography is an all-but-extinct method of visualizing the lymphatic drainage from an extremity using oil-based iodine contrast agents. More recently, interstitially injected intra-lymphatic imaging, such as lymphoscintigraphy, has been used for lymphedema assessment and sentinel node detection. Nevertheless, radionuclide-based imaging has the disadvantage of poor resolution. This has lead to the development of novel systemic and interstitial imaging techniques which are minimally invasive and have the potential to provide both structural and functional information; this is a particular advantage for cancer imaging, where anatomical depiction alone often provides insufficient information. At present the respective role each modality plays remains to be determined. Indeed, multi-modal imaging may be more appropriate for certain lymphatic disorders. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve diagnostic accuracy.
Collapse
Affiliation(s)
- Tristan Barrett
- Molecular Imaging Program, National Cancer Institute, Building 10, Room 1B40, Bethesda, MD 20892-1088, USA
| | | | | |
Collapse
|
44
|
Hama Y, Bernardo M, Regino CAS, Koyama Y, Brechbiel MW, Krishna MC, Choyke PL, Kobayashi H. MR lymphangiography using dendrimer-based contrast agents: A comparison at 1.5T and 3.0T. Magn Reson Med 2007; 57:431-6. [PMID: 17260373 DOI: 10.1002/mrm.21126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Most macromolecular contrast agents (CAs) show lower r1 and higher r2 relaxivities at 3.0T than at 1.5T. MR lymphangiography in mice using a macromolecular G6 dendrimer-based CA was serially performed and compared at both 1.5T and 3.0T. The r1 and r2 relaxivities of the G6 CA were 25 and 78/s/mM at 1.5T and 17 and 82/s/mM at 3.0T, respectively. The lymph node (LN)-to-fat ratios (LN signal intensity (SI)/fat SI) of T1-weighted 3D-fast spoiled gradient-echo (3D-FSPGR) were 3.2+/-0.4 (mean+/-standard deviation (SD)) at 1.5T and 2.7+/-0.3 at 3.0T (P=0.021), and the LN-to-fat ratios of T2/T1-weighted 3D-fast imaging employing steady-state acquisition with phase cycling (3D-FIESTA-C) were 1.8+/-0.2 at 1.5T and 1.2+/-0.4 at 3.0T (P=0.003). Although 3D-FSPGR successfully delineated the LNs at both 1.5T and 3.0T, 3D-FIESTA-C at 3.0T failed to visualize the LNs.
Collapse
Affiliation(s)
- Yukihiro Hama
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1088, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Kobayashi H, Kawamoto S, Bernardo M, Brechbiel MW, Knopp MV, Choyke PL. Delivery of gadolinium-labeled nanoparticles to the sentinel lymph node: comparison of the sentinel node visualization and estimations of intra-nodal gadolinium concentration by the magnetic resonance imaging. J Control Release 2006; 111:343-51. [PMID: 16490277 DOI: 10.1016/j.jconrel.2005.12.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 12/21/2005] [Accepted: 12/22/2005] [Indexed: 11/26/2022]
Abstract
Sentinel node imaging is commonly performed prior to surgery for breast cancer and melanoma. While current methods are based on radio-lymphoscintigraphy, MR lymphangiography (MRL) offers the benefits of better spatial resolution without ionizing radiation. However, the optimal nanoparticle for imaging the sentinel nodes remains unclear. Gadolinium-labeled (Gd) contrast agents ranging in diameter from <1 to 12 nm were evaluated to determine which size provides the most rapid and most concentrated delivery of contrast agent to the lymph nodes in a mouse model of lymphatic metastases. Specifically, PAMAM-G2, -G4, -G6 and -G8, and DAB-G5 Gd-dendrimer agents, as well as Gadomer-17 and Gd-DTPA, were compared. Among these agents, the G6 Gd dendrimer depicted the lymphatics and lymph nodes with the highest peak concentrations and this occurred 24-36 min post-injection (p<0.01; all except G8). Based on ex vivo concentration phantoms, high accumulations of Gd(III) ions occurred within lymph nodes (1.7-4.4 mM Gd/270-680 ppm Gd) with high target to background ratios (>100). These concentrations are sufficient to contemplate the use of Gd-neutron capture therapy of regional lymph nodes. Thus, when injected interstitially, the PAMAM-G6 Gd dendrimer not only provides excellent opacification of sentinel lymph nodes, but also provides the potential for targeted therapy of sentinel lymph nodes.
Collapse
Affiliation(s)
- Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 1B40, MSC1088, 10 Center Drive, Bethesda, MD 20892-1088, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Suga K, Shimizu K, Kawakami Y, Tangoku A, Zaki M, Matsunaga N, Oka M. Lymphatic drainage from esophagogastric tract: feasibility of endoscopic CT lymphography for direct visualization of pathways. Radiology 2006; 237:952-60. [PMID: 16304114 DOI: 10.1148/radiol.2373041578] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility of an endoscopic computed tomographic (CT) lymphography technique with submucosal injection of iopamidol for direct visualization of lymphatic drainage pathways in dogs and in patients with operable esophageal cancer. MATERIALS AND METHODS With institutional animal committee approval, a total of 2 mL of undiluted iopamidol was injected into the esophageal (n = 6) or gastric (n = 3) submucosa in nine dogs by using a flexible endoscope. Multi-detector row CT images (section thickness, 1.25 mm) were obtained before contrast material injection and during the 10 minutes after injection. The animals were euthanized so that their lymphatic anatomy could be examined. With ethical committee approval and patient informed consent, nine patients with esophageal cancer also underwent CT lymphography with peritumoral injection of 2 mL of iopamidol, followed by esophagectomy and regional lymph node dissection with CT lymphographic guidance. The histopathologic features of dissected nodes, including sentinel lymph nodes (SLNs), were examined. RESULTS CT lymphography depicted the direct connection of lymphatic drainage vessels with enhanced and/or unenhanced nodes (ie, SLNs) as early as within 5 minutes after contrast material injection in all subjects. All 13 SLNs in dogs (1.4 nodes per animal) and 18 SLNs in patients (two nodes per patient) were found and dissected at the correct location by using CT lymphographic guidance. In patients, histopathologic examination revealed the high predictive value of CT lymphographic-guided SLN biopsy: Only one of the preoperatively identified SLNs in three patients and both SLNs and adjacent nodes in two patients were positive for metastasis; all resected nodes in the remaining four patients were negative. CONCLUSION Endoscopic CT lymphography is a feasible method for visualizing the direct connection between and the accurate anatomic location of SLNs and lymphatic drainage vessels.
Collapse
Affiliation(s)
- Kazuyoshi Suga
- Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
| | | | | | | | | | | | | |
Collapse
|
47
|
Suga K, Yamamoto S, Tangoku A, Oka M, Kawakami Y, Matsunaga N. Breast Sentinel Lymph Node Navigation With Three-Dimensional Interstitial Multidetector-Row Computed Tomographic Lymphography. Invest Radiol 2005; 40:336-42. [PMID: 15905719 DOI: 10.1097/01.rli.0000164153.41638.32] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Three-dimensional multidetector-row computed tomographic lymphography (3D MDCT-LG) with interstitial injection of a widely available nonionic monometric contrast medium iopamidol was used for navigation of breast sentinel lymph node (SLN) biopsy. METHODS 3D MDCT-LG was obtained after massage of the interstitially injection sites of a total of 4-5 mL undiluted iopamidol at periareolar and peritumoral areas in 68 consecutive patients with early-stage breast cancer, using a 4 detector-row CT scanner. Drainage lymphatic patterns and SLN anatomy were assessed on 3D MDCT-LG images. 3D MDCT-LG-navigated SLN biopsy with combined use of blue dye was followed by backup axillary lymph node dissection to evaluate accuracy of SLN biopsy. RESULTS The 3D MDCT-LG images clearly localized primary SLNs by visualizing the direct connection between these nodes and their afferent lymphatic vessels on detailed anatomy of the surrounding structures in all patients. Drainage lymphatic pathways on these images were classified into 4 patterns: single route/single SLN (39 cases, 57%), multiple routes/multiple SLNs (10 cases, 15%), single route/multiple SLNs (9 cases, 13%), and multiple routes/single SLN (10 cases, 15%). Under 3D MDCT-LG navigation, SLNs was found at the accurate location in all patients. With backup axillary lymph node dissection, metastasis was found in 14 (20%) patients, and 8 of these patients had metastasis only in the preoperatively identified SLNs. In other 5 positive patients, metastasis was found both in the SLN and non-SLNs. However, micrometastasis eventually was found only in non-SLN in an elderly patient. Overall, the sensitivity, false-negative rate, and accuracy of 3D CT-L-navigated SLN biopsy were 92% (13/14 patients), 7% (1/14 patients), and 98% (67/68 patients), respectively. CONCLUSIONS Topographic 3D interstitial MDCT-LG can be a widely available and reliable navigator for breast SLN biopsy.
Collapse
Affiliation(s)
- Kazuyoshi Suga
- Department of Radiology, Yamaguchi University School of Medicine, Japan.
| | | | | | | | | | | |
Collapse
|
48
|
Tsuda N, Tsuji T, Kato N. Interstitial Magnetic Resonance Lymphography Using Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid in Rabbits With Lymph Node Metastasis. Invest Radiol 2005; 40:306-12. [PMID: 15829827 DOI: 10.1097/01.rli.0000160606.54347.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the dose dependency of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) for interstitial magnetic resonance (MR) lymphography and the detection of lymph node metastasis in rabbits. METHODS Eighteen VX2 tumor-bearing rabbits were subjected to MR lymphography using clinical MRI equipment. The enhancement of popliteal lymph nodes was studied in these rabbits before and at 2.5 to 10 minutes after the subcutaneous administration of 4, 8, or 17 micromol Gd/kg of Gd-EOB-DTPA in TSE and 3D-FLASH (n = 6). Signal-to-noise ratio and contrast-to-noise ratio were statistically compared between each group by the Tukey test. After MR imaging, the popliteal lymph nodes were removed, and sections were prepared for microscopic examination. RESULTS In the histologic findings, all metastases (3-12 mm) in the popliteal lymph nodes were detected by 3D-FLASH images. Gd-EOB-DTPA-enhanced T1WI showed a hypointense region for metastasis and a hyperintense region for nontumor regions, although the lymph nodes containing metastasis were detected as a hyperintense region by conventional PDWI and T2WI. Signal enhancement of the nontumor regions and contrast between the nontumor regions and metastasis showed dose dependency and reached a plateau at 8 micromol Gd/kg on T1WI (signal-to-noise ratio: 13.9 +/- 1.6; contrast-to-noise ratio: -12.7 +/- 1.7). CONCLUSIONS This study showed that interstitial MR lymphography with Gd-EOB-DTPA can detect metastasis and that the optimal dose in rabbits is 8 micromol Gd/kg as a subcutaneous application.
Collapse
Affiliation(s)
- Natsuko Tsuda
- DG & RP Business Unit, Nihon Schering K. K., Yodogawa-ku, Osaka, Japan.
| | | | | |
Collapse
|
49
|
Ikeda T, Jinno H, Fujii H, Kitajima M. Recent development of sentinel lymph node biopsy for breast cancer in Japan. Asian J Surg 2005; 27:275-8. [PMID: 15564178 DOI: 10.1016/s1015-9584(09)60050-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The number of breast cancer cases undergoing sentinel lymph node biopsy (SLNB) has been increasing with the number of articles published in Japan. SLNB using the dye method alone is performed in about one-third of patients. Analysis of questionnaire responses from 40 institutions in Japan revealed an identification rate by the dye method alone of 87%, compared with 96% using the combined method; the combined method is now recognized in Japan as superior to the dye method alone. No dyes have been specifically approved by the government for use in SLNB, and physicians have been using several inappropriate dyes as tracers for SLNB, such as indocyanine green, patent blue, indigo carmine, and isosulfan blue. The colloidal radiotracers used in Japan include tin colloid, stannous phytate, rhenium sulfate and human serum albumin. Albumin colloid and sulfur colloid are not commercially available in Japan. Small-size tin colloids, stannous phytate and rhenium sulfate all yield good results in terms of detection and false-negative rates. Provided that the surgeon has adequate experience in SLNB, a negative sentinel node can serve as a substitute for negative results from axillary lymph node dissection. Although many institutions have introduced SLNB, few reports have focused on the results of SLNB without axillary dissection because of short follow-up times and small number of patients. The final decision as to whether SLNB is an adequate substitute for axillary dissection awaits the results of prospective randomized trials.
Collapse
Affiliation(s)
- Tadashi Ikeda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | | | | | | |
Collapse
|
50
|
Ohta K, Takeuchi Y, Tozaki M, Iida T, Ohshita T, Takamura K, Fujioka M, Akazawa H. [Efficacy of three-dimensional image fusion of lymphoscintigraphy and MDCT data sets in breast cancer]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2004; 60:1424-8. [PMID: 15565011 DOI: 10.6009/jjrt.kj00003326544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The aim of this study was to evaluate the clinical usefulness of image fusion of lymphoscintigraphy with (99m)Tc phytate and volume-rendering images generated by multidetector-row CT (MDCT) in patients with breast cancer. The subjects were 25 patients with clinically negative nodes. Data from the two imaging modalities were fused on a personal computer. Thirty-five axillary sentinel nodes were identified by lymphoscintigraphy. The anatomical locations of sentinel nodes in 27 patients were clearly demonstrated by 3D-fusion imaging (84%). Image fusion of lymphoscintigraphy with (99m)Tc phytate and volume-rendering images is helpful for sentinel node biopsy in breast cancer.
Collapse
Affiliation(s)
- Katsurou Ohta
- Radiological Division, Daisan Hospital, Jikei University School of Medicine
| | | | | | | | | | | | | | | |
Collapse
|