Objective: To explore the clinical value of CT lymphography (CT-LG) on the localization and evaluation of sentinel lymph node (SLN) in patients with early-stage breast cancer. Methods: Thirty-six patients with early-stage breast cancer were enrolled in this study from September 2014 to June 2016 in the First Hospital of Zhengzhou University.The diagnoses were confirmed by puncture or local surgical pathology with negative clinical palpation of axillary lymph nodes, and sentinel lymph node biopsy (SLNB) was planned.The patients received CT-LG examination.The first one or several lymph nodes along the lymph duct draining from the injection site to axilla was/were defined as SLN(s), and the results were compared with the SLNB.Wilcoxon signed ranks test was used to compare the number of SLN detected by CT-LG and SLNB; according to the pathologic results, Student t test or chi-square test was used to compare the differences of the positive SLNs with negative ones. Results: SLNs were successfully identified in all 36 patients, 32 cases (88.9%) had high-quality images (with both SLN and lymphatic vessel visible); 36 SLNs were located by CT-guided wire with a success rate of 100%.A total of 88 SLNs were identified by CT-LG in 36 patients, and 102 SLNs were obtained by SLNB (Z=-2.646, P=0.008). The long-short diameter ratio (L/S) of SLN obtained by SLNB was significantly smaller than that of CT-LG (1.7±0.3 vs 1.9±0.4, t=2.880, P=0.004). Compared with pathology, CT-LG showed 21 positive SLNs and 67 negative SLNs, and the short diameter of positive SLNs was bigger than that of negative ones[(5.9±2.1) vs (4.8±1.8) mm, t=2.235, P=0.028]. Of 67 negative SLNs, 61(91.04%) appeared homogenously contrast agent filling, and 13(61.90%) of the 21 positive SLNs were found filling defect changes, and the differences in filling defect changes between positive and negative SLNs were statistically significant (χ(2)=26.479, P<0.001). Conclusion: CT-LG can accurately locate the SLN for early-stage breast cancer, and both the short diameter and filling defect changes can help evaluate the status of SLN.
目的： 初步探讨CT淋巴管造影(CT－LG)定位及评价早期乳腺癌前哨淋巴结(SLN)状态的临床价值。 方法： 对2014年9月至2016年6月于郑州大学第一附属医院穿刺或局部手术病理证实且临床触诊腋窝淋巴结阴性拟行SLN活检(SLNB)的36例早期乳腺癌患者行CT－LG检查。定义自造影剂注射部位至腋窝方向的引流淋巴管上最先显像的1个或数个淋巴结为SLN，并与SLNB结果对照。对CT－LG和SLNB检出的SLN数目作Wilcoxon秩和检验；依据病理结果，对阳性和阴性SLN的长径、短径、长短径比(L/S)、SLN是否出现充盈缺损及有无卫星淋巴结作Student t检验或χ(2)检验。 结果： 36例患者CT－LG检查均见SLN显像，32例(88.9%)图像效果良好(SLN及淋巴管均显像)；CT引导下导丝共定位36枚SLN，定位成功率为100%。36例患者CT－LG显示SLN 88枚，SLNB获得SLN 102枚，两种方法差异有统计学意义(Z＝－2.646，P＝0.008)；SLNB检出SLN的L/S较CT－LG小(1.7±0.3比1.9±0.4)，差异有统计意义(t＝2.880，P＝0.004)。对照病理，CT－LG共检出21枚阳性SLN，67枚阴性SLN，且阳性SLN短径较阴性大[(5.9±2.1)比(4.8±1.8) mm]，差异有统计意义(t＝2.235，P＝0.028)。67枚阴性SLN中，61枚(91.04%)对比剂充填均匀，21枚阳性SLN中，13枚(61.90%)出现充盈缺损样改变，阳性及阴性SLN中充盈缺损改变差异有统计学意义(χ(2)＝26.479，P<0.001)。 结论： CT－LG检查可准确定位早期乳腺癌SLN，短径、淋巴结内充盈缺损改变可有助于评价SLN的性质。.
Keywords: Breast neoplasms; Lymphography; Sentinel lymph node; Tomography, X-ray computed.