Lymph-node staining with activated carbon CH40: A new method for axillary lymph-node dissection in breast cancer

OBJECTIVE: To demonstrate the usefulness of activated carbon particles (CH4 0) as a vital staining dye for visualizing lymphatic vessels and lymph node s in breast cancer. DESIGN: A retrospective evaluation. SETTING: Department of Surgery in Sendai National Hospital, Japan, a 716-be d teaching hospital. METHODS: To identify as many lymph nodes as possible in the axillary fat, b y which we might decrease the possibility of the presence of undetected met astatic nodes, an emulsion of activated carbon particles (CH40) was injecte d into the centre of the mammary gland, close to the: tumour site, 3 days b efore radical surgery. MAIN OUTCOME MEASURE: The number of lymph nodes found by the traditional me thod and by the CH40-injection method were recorded. RESULTS: After injection, the CH40 was readily adsorbed into regional lymph atics and streamed along with the lymph flow to blacken regional lymph node s, The CH40-guided method increased the mean number of nodes per case found in the axilla from 8.4, by the traditional method, to 14.0 nodes per case. CONCLUSIONS: The use of the CH40 technique has two technical advantages; on e is that it allows surgeons to locate the blackened lymph nodes at the tim e of surgery and the other is that it allows pathologists to look for the n odes in fatty tissue. Lymph-node dissection with the aid of activated carbo n particles is inexpensive, easy to perform and enables the smallest lymph nodes to be easily recognized. CH40 is the technique of choice for the dete ction of axillary lymph nodes in cases where the number of lymph nodes dete cted by the traditional method is too small for accurate surgery. In conclu sion the present study demonstrates that CH40 could be an appropriate tool for more accurate staging of breast cancer axillary specimens.