The combination of preoperative computed tomography lymphography and intraoperative fluorescence imaging navigation for sentinel lymph node biopsy of early breast cancer patients.

567 Background: This study investigated a usefulness of the combination of fluorescence imaging and computed tomography lymphography (CTLG) for sentinel lymph node biopsy (SLN) biopsy of early breast cancer patients. Methods: Between January 2013 and August 2016, 350 breast cancer patients without clinical evidence of lymph node metastasis were treated. Preoperaitve CTLG was performed using 64-row multidetector CT injected contrast agent. The contrasted lymph route and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. We established typical pattern of the lymphography: stain defect of SLN, stagnation of lymphatic route for preoperative diagnosis of metastatic SLN. Intraoperative fluorescence images were obtained using the fluorescence imaging system (pde-neo). After dye mixed indocyanine green and indigocarmin was injected, lymphatic route was observed with fluorescence images. SLN biopsy was performed referring to the point by axillary compression technique by plastic device. Results: The median age of the 350 patients was 59 (range 28 – 90) years old. CTLG could visualize lymphatic route and accurately identify SLN in 336 (96.0 %) and 343 (98.0 %) cases, respectively, whereas fluorescence imaging identified successfully lymphatic route and SLN in all patients. Lymphatic routes of CTLG were completely consistent with those of fluorescence imaging. The number of SLN identified by CTLG was significantly lower than that by fluorescence imaging (1.1 vs. 1.6, p<0.01). Fifty of 350 patients had metastatic SLN pathologically, and 11 of them had micrometastases of SLNs. The accuracy for metastatic diagnosis of SLN using CTLG without micrometastasis was 84.1 %, sensitivity was 82.1 % and specificity was 84.3 %. The positive predictive value was 40.5 % and negative predictive value was 97.3 %. Conclusions: This combined navigation method of fluorescence imaging and CTLG revealed more easy and effective to detect SLN than fluorescence imaging alone. In addition, the information from CTLG would be helpful for the preoperative diagnosis of SLN metastasis.