Related Experiment Video
Updated: Jul 6, 2026
Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery
Published on: April 3, 2026
Evaluation of sentinel lymph node metastasis alone guided by three-dimensional computed tomographic lymphography in
1Department of Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan. yamasita@nms.ac.jp
Background:
Detailed relations between lymph nodes and lymph flow can be clarified by three-dimensional computed tomographic (3D-CT) lymphangiography. Systematic collection of lymph nodes based on 3D-CT lymphangiography can decrease unnecessary lymph node dissection and attendant complications.
Methods:
To mark the sentinel lymph node (SLN) on the skin, 3D-CT lymphangiography was performed the day before the surgery. Iopamiron 300 (2 ml) was injected subcutaneously. A 16-channel multidetector-row helical CT scan image was reconstructed to produce a 3D image of lymph ducts and lymph nodes. Biopsy of SLN was performed by a dye-staining method using Visiport-aided endoscopy. Stained lymph nodes were located by following the dye in the lymph ducts on a video monitor. For SLN-metastasis-positive patients, standard axillary lymph node dissection (levels 1 and 2) was performed with video assistance.
Results:
Since December 2001, video-assisted breast surgery has been performed for 180 patients, SLN biopsy for 150 patients, and 3D-CT lymphangiography for 110 patients. Findings show that SLN-positive metastasis (n = 31) was accompanied by SLN metastasis alone in 14 patients. One-node metastasis, except for SLN, was observed in seven patients, two-node metastasis in three patients, and metastasis involving more than three nodes in seven patients. Review of the lymphoid path using 3D-CT lymphangiography confirmed that metastasis occurred in order of lymph flow.
Conclusions:
Absence of metastasis in the second and third SLNs, even in patients with SLN metastasis, obviates the need for dissection of more nodes.
