Methodology: CT Lymphography
Sentinel lymph node (SLN) navigation surgery became the routine clinical procedure in breast cancer (BC) surgery. SLN navigation has also been introduced to gastrointestinal cancer but still remains controversial for esophageal cancer, because the lymphatic network spread widely from the abdomen to the neck compared with gastric and colon cancer. We developed SLN navigation surgery using multidetector (MD) computed tomography lymphography (CTLG) with a water-soluble iodine tracer injection in BC, which predict not only the precise number and location of the SLNs but also the existence of lymph node metastasis surrounding detailed anatomy, during a screening CT for metastasis.
During the surgery, indocyanine green (ICG) solution was injected around the tumor. SLNs were identified using ICG fluorescence imaging (IGFI) navigated by preoperative CTLG. Lymphatic vessels and SLNs were clearly visualized, and SLNs were identified and sampled using IGFI referring to CTLG, resulting in successful SLN navigation.
The results that micrometastases were existed only in the SLNs which were detected by CTLG navigation authorize the reliability of this method.
KeywordsSentinel lymph node (SLN) Navigation surgery CT lymphography Superficial esophageal cancer Minimal invasive surgery
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