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Ann Thorac Surg 2004;77:1033-1037
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Preoperative imaging of the lung sentinel lymphatic basin with computed tomographic lymphography: a preliminary study

^a First Department of Surgery, Yamaguchi University School of Medicine, Ube Yamaguchi, Japan
^b Department of Radiology, Yamaguchi University School of Medicine, Ube Yamaguchi, Japan

Accepted for publication September 10, 2003.

^* Address reprint requests to Dr Kazuhiro Ueda, First Department of Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube Yamaguchi 755-8505, Japan
e-mail: kaueda{at}yamaguchi-u.ac.jp

BACKGROUND: Preoperative localization of the sentinel node basin would guide selective lymph node dissection. We tried to identify these nodal stations with indirect computed tomographic lymphography using a conventional extracellular contrast agent, iopamidol.

METHODS: Eleven consecutive patients scheduled to undergo anatomic resection of suspected lung cancer, without lymphadenopathy, were given a peritumoral injection of undiluted iopamidol under computed tomography guidance, and lymphatic migration was assessed by multidetector-row helical computed tomography.

RESULTS: There were no complications such as bleeding, pneumothorax, or allergic reactions. Enhanced nodes were detected in all but 1 patient who had diffuse lymph nodal calcification. Enhanced nodes were identified at 32 ipsilateral intrathoracic nodal stations (20 hilar stations and 12 mediastinal stations). The average length of the longer axis of the enhanced nodes was 4.8 mm (range, 3 to 8 mm), and the average attenuation of the enhanced nodes was 132 (range, 46 to 261) Hounsfield units. In 9 patients with confirmed lung cancer, enhanced nodes appeared at 26 nodal stations, and all apparent enhanced nodes were identified as actual lymph nodes at appropriate position during lymphadenectomy. None of the resected lymph nodes had metastatic involvement.

CONCLUSIONS: Indirect computed tomographic lymphography with the peritumoral injection of iopamidol effectively depicts the drainage nodes unless they are diffusely calcified. Although further study is required, this method could guide selective lymph node dissection.

This article has been cited by other articles:

				K. Ueda, Y. Kaneda, M. Sudo, M. Jinbo, K. Suga, and K. Hamono Cerebral Air Embolism During Imaging of a Sentinel Lymphatic Drainage in the Respiratory Tract Ann. Thorac. Surg., February 1, 2006; 81(2): 721 - 723. [Abstract] [Full Text] [PDF]

				K. Suga, K. Shimizu, Y. Kawakami, A. Tangoku, M. Zaki, N. Matsunaga, and M. Oka Lymphatic Drainage from Esophagogastric Tract: Feasibility of Endoscopic CT Lymphography for Direct Visualization of Pathways Radiology, December 1, 2005; 237(3): 952 - 960. [Abstract] [Full Text] [PDF]