Background: Sentinel node biopsy often results in the identification and removal of multiple nodes as sentinel\r\nnodes, although most of these nodes could be non-sentinel nodes. This study investigated whether computed\r\ntomography-lymphography (CT-LG) can distinguish sentinel nodes from non-sentinel nodes and whether sentinel\r\nnodes identified by CT-LG can accurately stage the axilla in patients with breast cancer.\r\nMethods: This study included 184 patients with breast cancer and clinically negative nodes. Contrast agent was\r\ninjected interstitially. The location of sentinel nodes was marked on the skin surface using a CT laser light navigator\r\nsystem. Lymph nodes located just under the marks were first removed as sentinel nodes. Then, all dyed nodes or\r\nall hot nodes were removed.\r\nResults: The mean number of sentinel nodes identified by CT-LG was significantly lower than that of dyed and/or\r\nhot nodes removed (1.1 vs 1.8, p <0.0001). Twenty-three (12.5%) patients had =2 sentinel nodes identified by CT-LG\r\nremoved, whereas 94 (51.1%) of patients had =2 dyed and/or hot nodes removed (p <0.0001). Pathological\r\nevaluation demonstrated that 47 (25.5%) of 184 patients had metastasis to at least one node. All 47 patients\r\ndemonstrated metastases to at least one of the sentinel nodes identified by CT-LG.\r\nConclusions: CT-LG can distinguish sentinel nodes from non-sentinel nodes, and sentinel nodes identified by\r\nCT-LG can accurately stage the axilla in patients with breast cancer. Successful identification of sentinel nodes using\r\nCT-LG may facilitate image-based diagnosis of metastasis, possibly leading to the omission of sentinel node biopsy.
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