Chinese incidence of breast cancer has
increased remarkably with the socioeconomic development, particularly in
eastern coastal areas, and it has been expected to approach more than 100 cases
per 100000 women aged 55~69 years by 2021. Whereas, benefitting from
systemic therapy, the invasiveness of surgical treatment has been largely
controlled. Clinical trials have revolutionized the pattern of clinical
practice. Mastectomy and Axillary Lymph Node Dissection (ALND) were both
profoundly proven not to improve survival and Quality of Life (QOL) when
comparing with Breast-Conserving Therapy (BCT) and Sentinel Lymph Node Biopsy
(SLNB) [3,4]. National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32
and other trials identified that SLNB could not only reduce the surgical
morbidities, but could also be reliable for axillary staging of clinically
lymph node negative (cN0) breast cancer.
SNB has become the standard of care in
patients with cN0 disease. Although blue dye and radioisotope (RI) combined
lymphatic mapping was well established as a standard procedure to limit FNR but the optimal protocol for SLNB is still
under investigation. In many Japanese hospitals, due to the lack of RI,
contrast enhanced CT Lymphography (CT-LG) has been routinely used to stage the
axilla accurately with dye-only SLNB. It was concluded that using the only
size criterion by CT-LGor MRI alone to diagnose SLNs was not sufficient. No
matter what contrast regimen used, the cost and procedure of the technique they
used were not practical in China.
Based on previous studies on
ultrasonography and CT-LG, metastatic nodes have several abnormal signs. In our
daily wok, US-guided Core Needle Biopsy (CNB) and unenhanced chest CT have
routinely been preoperatively adopted to evaluate node status and triage the
patients. Because of unavailable RI and limited financial support in our
country, most of patients, especially who live in remote rural areas, must
receive more unnecessary ALND. In this context, we conduct this research to
evaluate an unenhanced chest CT assisted method for SLNB and provide an
alternative option for the given population.
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