The Application Of Preoperative CT Lymphography And Methylene Blue And Indocyanine Green Double-tracer Mapping In Fluorescence Endoscopic Sentinel Lymph Node Biopsy

Purpose1.To explore the application value of preoperative computed tomographic lymphography(CT-LG)in sentinel lymph node biopsy(SLN)localization in endoscopic sentinel lymph node biopsy(ESLNB).2.To explore the application value of perioperative SLN mapping with methylene blue(MB)and indocyanine green(ICG)in fluorescence endoscopic sentinel lymph node biopsy.Method1.Fifty-six patients with primary breast cancer and no clinical evidence of lymph node metastasis underwent CT-LG one day before ESLNB.The relationship between the success rate of CT-LG and the clinical characteristics of patients was analyzed,and the pattern of SLN and lymphatic ducts connection in CT-LG,the image characteristics of SLN and lymphatic ducts were recorded.2.On the day of surgery,the same group of patients received dual-tracer SLNB by fluorescence endoscopy with MB and ICG.The success rate of MB and ICG tracers and whether the SLN staining pattern can predict SLN metastasis were analyzed.Results1.The identification rate of SLN by CT-LG was 69.6%(39/56).The identification of SLN by CTLG is not related to age and BMI of patients,and location,quadrant,pathological stage,histological type and molecular type of primary tumor,but might be associated with SLN metastasis.In CT-LG,there are five connection modes of lymphatic ducts to SLN:single lymphatic duct to single lymph node,multiple lymphatic ducts to single lymph node,single lymphatic duct to multiple lymph nodes,multiple lymphatic ducts to multiple lymph nodes,and only lymphatic duct.There are four special imaging manifestations in CT-LG of patients with metastatic SLN:including inhomogeneously enhanced lymph node,stagnant lymphatic duct,lymphatic duct dilatation,lymphatic duct detoured.The sensitivity,specificity,positive predictive value and negative predictive value of SLN metastasis with these special manifestations were 100%,71.4%,57.9%and 100%respectively.2.The identification rate of SLN mapping with MB alone was 87.5%(49/56),and was 100%when with MB and ICG.In case of partial staining,the rate of metastasis was higher compared to the cases of whole staining when use MB only.There were 6 staining patterns in SLN mapping by MB and ICG in fluorescence endoscopic sentinel lymph node biopsy.91.8%of SLN in ICG++MB++pattern were non-metastatic.Conclusions1.CT-LG can obtain the information of the relationship between SLN and lymphatic ducts and the location of SLN before surgery.It is significant to establish working space for endoscopic sentinel lymph node biopsy(ESLNB).Special imaging manifestations of lymph nodes and lymphatics in CT-LG can predict the presence or absence of metastatic SLN.2.The identification rate of SLN could be improved by double tracers mapping with MB and ICG in fluorescence endoscopic sentinel lymph node biopsy.The staining of lymph nodes and lymphatic ducts mapping by MB and ICG could be seen in the same picture.The first lymph node drained from the mammary gland with both MB staining and ICG fluorescence could be accurately found.