吲哚菁绿联合美蓝在乳腺癌腋窝前哨淋巴结活检的临床应用价值

目的:探讨吲哚菁绿（indocyanine green,ICG ）荧光导航法联合美蓝示踪法在乳腺癌腋窝前哨淋巴结活检（sentinel lymph node biopsy ,SLNB）中的临床应用价值。方法:收集2013年5 月至2014年4 月广东省汕头中心医院符合入组标准的89例早期乳腺癌患者。其中第一阶段,53例术中行ICG 联合美蓝注射,并利用淋巴荧光显像及美蓝示踪行前哨淋巴结活检术联合腋窝淋巴结清扫术（axillary lymph node dissection ALND ）;第二阶段,36例术中前哨淋巴结（sentinel lymphnode ,SLN ）冰冻病理阴性患者不再行腋窝淋巴结清扫。统计SLN 的检出成功率、准确率及假阴性率。结果:89例患者的SLN 检出成功率为96.6%（86/ 89）,第一阶段检出成功率为94.3%（50/ 53）、准确率98.0%（49/ 50）、假阴性率2.6%（1/ 38）,第二阶段检出成功率为100%（36/ 36）。 ICG 荧光导航法联合美蓝示踪法检出196 枚SLN 中荧光显示为179 枚,196 枚SLN 其中显示蓝染142 枚、未显示蓝染的54枚仅显示荧光。196 枚SLN 中有转移为45枚,5 枚仅显示荧光。22例患者SLN 转移,转移率为24.7%（22/ 89）,2 例患者的SLN 仅显示荧光而未蓝染。中位随访时间为25个月,未发现同侧区域淋巴结复发。结论:ICG 荧光导航法联合美蓝示踪法能够安全有效地应用于乳腺癌前哨淋巴结活检。      

乳腺癌前哨淋巴结的临床研究

目的：探讨前哨淋巴结活检（sentinel lymph node biopsy，SLNB）在乳腺癌临床应用中的可行性、准确性。方法：术前肿瘤表面或活检腔周围皮内注射99mTc-DX，进行前哨淋巴结（sentinel lymph node，SLN）显像、体表定位；术中r-探测仪识别SLN，先行SLNB，再行乳腺癌根治术或改良根治术，术后对SLN和腋窝淋巴结清扫（axillary Lymph Node Dissectio，ALND）的病理结果进行综合分析。结果：淋巴闪烁显像和r-探测器联合应用检测SLN准确率为96.9％，敏感度为90.9％，假阴性率为9.1％，假阳性率为0。结论：SLNB是乳腺癌治疗中的一项新技术，能高灵敏度反应腋淋巴结状态。     

1枚前哨淋巴结阳性早期乳腺癌保腋窝的可行性分析

目的探讨1枚前哨淋巴结（sentinel lymph node,SLN）阳性的早期乳腺癌患者保腋窝（omitting axillary dissection,OAD）的可行性。方法用美蓝作为示踪剂先行乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）,根据快速冰冻病理结果分为SLN阴性组与1枚SLN阳性组,随后两组均行常规腋窝淋巴结清扫（axillary lymph node dissection,ALND）以解剖出非前哨淋巴结（non—sentinellymphnode,NSLN）,比较两组间NSLN的阳性率。结果SLN阴性组30例,1例NSLN阳性,阳性率为3．3％,准确性为96．7％（29／30）;1枚SLN阳性组30例,仅3例NSLN阳性,阳性率为10．0％;两组阳性率差异无统计学意义（X^2=1．071,P=0．612）。全组随访1～48个月,均无区域淋巴结复发。结论1枚SLN阳性的早期乳腺癌患者可考虑OAD。     

乳腺癌前哨淋巴结活检术的发展历史及研究进展

乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）是一项兼具诊断及治疗目的的外科技术，是近年来乳腺外科领域具有里程碑意义的重大进展之一。作为一种腋窝微创外科术式，在乳腺癌综合治疗效果不断提高的背景下，SLNB在近40年的发展呈现出降阶梯趋势，也从侧面反映出乳腺癌作为一种全身性疾病的生物学本质。首先，米兰SLNB185、NSABP-B32等一系列前瞻性随机对照临床试验证实，SLNB可以作为临床腋窝淋巴结阴性早期乳腺癌准确的腋窝分期手段。ACOSOG Z0011、IBCSG 23-01等临床试验结果则进一步丰富了腋窝外科手术降阶梯的概念，前哨淋巴结（sentinel lymph node,SLN）阳性的患者手术范围缩小，即SLN低肿瘤负荷患者中，SLNB可以安全替代腋窝淋巴结清扫（axillary lymph node dissection,ALND）。随后，SLNB以及由此衍生而来的标记淋巴结活检将腋窝微创手术的可行性人群范围进一步扩展到了新辅助治疗的患者。近年来，以EUBREAST-061为代表的回顾性研究及有限的前瞻性研究数据初步证实了腋窝降阶梯...     

染色法乳腺癌前哨淋巴结活检的临床应用价值

[目的]探讨染色法乳腺癌前哨淋巴结(sentinel lymph node,SLN)活检对腋淋巴结(axillary lymph node,ALN)转移预测的准确性.[方法]采用亚甲蓝染色法对50例乳腺癌行腋窝蓝染淋巴结活检,后行常规腋窝淋巴结清扫,两标本均送病理检查.[结果]全组50例患者检出SLN 48例,2例未找到SLN,检出率为96%(48/50);SLN与ALN病理检查完全符合者47例,准确率为97.9%(47/48);灵敏度为88.9%(8/9);假阴性率为11.1%(1/9).[结论]前哨淋巴结活检能准确预测乳腺癌腋窝淋巴结状态,亚甲蓝染色法可以成功确定SLN.     

乳腺癌新辅助化疗后腋窝及内乳前哨淋巴结活检研究

背景与目的：临床新辅助化疗(neoadjuvant chemotherapy,NAC)后腋窝淋巴结(axillary lymph node,ALN)转阴的患者腋窝前哨淋巴结活检(axillary sentinel lymph node biopsy, ASLNB)能否替代腋窝淋巴结清扫(axillary lymph node dissection,ALND)尚存在争议,且此前研究只评估ALN病理状况而未评估内乳淋巴结(internal mammary lymph node,IMLN)状况。本研究旨在评估NAC后乳腺癌患者接受ASLNB和内乳前哨淋巴结活检(internal mammary sentinel lymph node biopsy,IM-SLNB)的临床意义。方法：回顾性分析2012年1月—2014年12月山东省肿瘤医院乳腺病中心原发性乳腺癌(cT_1-4N_0-3M₀)60例患者的临床资料,将患者分为3组：A组初始cN₀且NAC后为ycN₀,B组初始cN+且NAC后为ycN₀,C组NAC后为ycN₊。术前接受核素注射。术中A组和B组联合亚甲蓝行ASLNB。A组仅对腋窝前哨淋巴结(axillary sentinel lymph node,ASLN)阳性者行ALND;B组行ASLNB后转行ALND;C组直接行ALND。术前淋巴显像和(或)γ探测仪发现内乳前哨淋巴结(internal mammary sentinel lymph node,IM-SLN)的患者行IM-SLNB。结果：A组、B组和C组分别收集6例、45例和9例。A组ASLNB成功率为100%(6/6),仅1例ASLN阳性转行ALND。B组ASLNB成功率为100%(45/45),假阴性率为17.9%(5/28)。其中检出1枚、2枚和＞2枚ASLN的假阴性率分别为27.3%(3/11)、20.0%(2/10)和0%(0/7)。C组所有患者ALN均有转移。IM-SLN总体显像率为63.3%(38/60)。IM-SLNB的总体成功率为97.4%(37/38),转移率为8.1%(3/37),并发症发生率为5.3%(2/38)。结论：对初始cN₀且NAC后为ycN₀者ASLN阴性时ASLNB可替代ALND;对初始cN₊且NAC后为ycN₀者,联合双示踪剂且检出＞2枚ASLN可满足临床可接受的假阴性率(<10%);对NAC后仍为ycN₊者应行ALND。NAC后IM-SLN显像者应行IM-SLNB,以获得完整分期、评估预后并指导术后放疗,有望完善病理完全缓解(pathological complete response,pCR)定义。     

中国乳腺癌前哨淋巴结活检现状调查研究

背景与目的：前哨淋巴结活检（sentinel lymph node biopsy,SLNB）已经成为乳腺癌临床腋窝淋巴结阴性患者的标准腋窝分期方案。由中国抗癌协会乳腺癌专业委员会发起的SLNB调查研究,旨在了解中国大型医院乳腺癌SLNB的开展现状。方法：在全国范围内纳入2017年手术量大于200例的医院,共110家医院完成问卷调查。调查问卷包括SLNB的开展现状、免除腋窝清扫及新辅助化疗（neoadjuvant chemotherapy,NAC）中SLNB的应用等热点问题。采用χ ² 检验、Fisher确切概率法或Kolmogorov-Smirnov检验对数据进行分析。结果：参与调研的110家医院均开展了SLNB,其中,85家（77.27%）医院对超过50%的临床腋窝淋巴结阴性（cN ₀ ）乳腺癌患者常规进行SLNB。肿瘤专科医院（χ ² =5.62,P=0.018）、保乳手术（breast-conserving surgery,BCS）量较大的医院（D=0.33,P=0.032）开展SLNB的比例更高。大部分医院（93/110,84.55%）未开展内乳SLNB。最常用的示踪方法为染料（主要是亚甲蓝,69/110,62.73%）,仅14.55%（16/110）的医院使用核素联合染料双示踪法。几乎所有的医院（107/110,97.27%）均采用术中快速冰冻切片对前哨淋巴结（sentinel lymph node,SLN）进行病理学诊断。对于cN ₀ 、SLN 1~2枚转移的BCS患者,大部分医院（61/110,55.45%）仅对少于10%的该类患者免除后续腋窝淋巴结清扫（axillary lymph node dissection,ALND）。对于cN ₀ 、SLN 1~2枚转移的全乳切除患者,84家（76.36%）医院对少于10%的此类患者免除后续ALND。对于接受NAC的患者,50家（45.45%）医院在NAC后进行SLNB,60家（54.55%）医院在NAC前进行SLNB。行NAC较多的医院（χ ² =4.365,P=0.037）、在NAC期间常规使用磁共振成像（magnetic resonance imaging,MRI）评估的医院（χ ² =10.967,P=0.004）,更倾向于在NAC后行SLNB。结论：尽管示踪剂的规范应用尚有待改进,早期乳腺癌患者的SLNB已经成为中国评估腋窝状态的标准方式。对于SLN转移负荷较低的患者,国内学者对于免于腋窝清扫仍较为保守。接受NAC的患者,SLNB的应用时机仍存在争议。     

临床淋巴结阳性新辅助治疗后腋窝降阶处理的研究进展

在优效系统治疗和精准放疗的时代背景下，乳腺癌新辅助治疗（neoadjuvant treatment,NAT）有助于乳房肿瘤降期实现保乳和腋窝降期，使患者豁免腋窝淋巴结清扫（axillary lymph node dissection,ALND）。目前，在临床腋窝淋巴结阳性的患者中，人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性和三阴性乳腺癌（triplenegativebreastcancer,TNBC）亚型接受NAT后可达到较高的腋窝病理学完全缓解率（axillarynodalpathologiccomplete response,apCR），有望实现腋窝局部降阶梯处理，相关指南与专家共识推荐初始临床淋巴结阴性（clinicallymphnode negative,cN0）的患者NAT后前哨淋巴结（sentinel lymph node,SLN）阴性可行前哨淋巴结活检（sentinel lymph node biopsy,SLNB）替代ALND,NAT后SLN存在较低肿瘤残留负荷的患者可考虑放疗替代ALND。初始...     

分子分型与乳腺癌新辅助化疗腋窝降阶梯手术的研究

  目的  探讨临床淋巴结阴性患者新辅助化疗（neoadjuvant chemotherapeutic,NAC）与前哨淋巴结活检（sentinel lymph node biopsy,SLNB）的最佳时机,评估临床淋巴结阳性患者行NAC后腋窝降阶梯手术可能获益人群。  方法  回顾性分析2010年10月至2017年11月山东大学附属山东省肿瘤医院收治206例行NAC患者的临床病理资料,分析分子分型与腋窝淋巴结病理完全缓解（axillary nodal pathologic complete response,apCR）的关系。  结果  206例行NAC患者中183例为临床淋巴结阳性,apCR为33.3%（61/183）。Luminal型HER-2阴性患者apCR为19.8%（17/86）,与HER-2阳性行靶向治疗患者apCR的62.1%（18/29）、HER-2阳性未行靶向治疗的34.5%（10/29）及三阴性乳腺癌（triple-negative breast cancer,TNBC）的41.0%（16/39）相比显著降低,差异具有统计学意义（P < 0.001）。23例临床淋巴结阴性患者行NAC后前哨淋巴结阳性率为26.1%（6/23）,Luminal型HER-2阴性、TNBC和HER-2阳性患者前哨淋巴结阳性率分别为36.4%（4/11）、25.0%（1/4）和12.5%（1/8）。  结论  分子分型与行NAC后的apCR相关。对临床淋巴结阴性的Luminal型HER-2阴性患者,NAC前行SLNB可避免腋窝淋巴结清扫,对临床淋巴结阴性的TNBC和HER-2阳性患者,建议NAC后行SLNB。临床淋巴结阳性且行NAC降期转阴的TNBC和HER-2阳性患者,从NAC后的腋窝降阶梯手术中可能获益更多。      

乳腺癌前哨淋巴结活检的可行性及临床应用价值

目的 探讨前哨淋巴结(sentinel Iymph node,SLN)定位和活检(SLNB)的可行性及其对预测乳腺癌腋窝淋巴结(axillary lymph node,ALN)转移的准确性。方法 对52例临床查体及B超检测ALN阴性的乳腺癌患者,术中在肿瘤周围注射亚甲蓝进行SLN定位和活检。对常规病理检查阴性的SLN再行免疫组化检测。结果 SLNB的检出成功率为92.3％(48/52),准确率为97.9％,假阴性率为4.8％,敏感度为95.2％,特异度为100％。SLN是惟一被证实有肿瘤转移的淋巴结者占66.7％(14/21)。免疫组化检测使SLN肿瘤转移的阳性率提高了4.1％。结论乳腺癌SLNB技术是可行的,应用亚甲蓝淋巴定位方法进行的SLNB可以准确预测临床及B超检查ALN阴性的乳腺癌患者的ALN转     

Sentinel Node Biopsy After Neoadjuvant Chemotherapy in Cytologically Proven Node-Positive Breast Cancer

IntroductionSeveral studies have assessed the feasibility of sentinel lymph node biopsy (SLNB) after NAC in patients with breast cancer, but diagnostic accuracy has varied. We prospectively evaluated the diagnostic accuracy of SLNB in detecting axillary lymph node (ALN) metastases after NAC in patients with cytologically proven positive nodes before chemotherapy.Patients and MethodsWe studied 95 breast cancer patients with cytologically proven positive nodes and a partial or complete clinical response to NAC in the breast lesions confirmed using magnetic resonance imaging. Patients then underwent SLNB followed by ALN dissection. The identification rate of sentinel lymph nodes (SLNs) and the false negative rate of nodal metastases were assessed. Subgroup analysis was conducted according to several clinical factors.ResultsSLNs were successfully identified in 81 (85.3%) of the 95 patients. Among these 81 patients, 51 (63.0%) had ALN metastases on final pathologic examination after NAC. Eight of the 51 patients with ALN metastases had negative results on SLNB (false negative rate, 15.7%). Univariate analysis indicated that the false negative rate was significantly lower only in the HER2-negative group (P = .003).ConclusionSLNB after NAC did not correctly predict the presence or absence of axillary node metastases in patients with breast cancer who had cytologically proven positive nodes before NAC. However, the diagnostic accuracy might be different in cancer subtypes, therapeutic effect of chemotherapy, or sentinel lymph node status after chemotherapy. Well-powered studies are needed to confirm diagnostic accuracy of SLNB after NAC according to subgroup in patients with breast cancer.     

Prospective study found thatperipheral lymph node sampling reduced the false-negative rate ofsentinel lymph node biopsy forbreast cancer

Background:Although sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false?negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). The purpose of this study was to evaluate the clinical signiifcance of SLNB combined with peripheral lymph node (PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of “skip metastasis” on the FNR of SLNB. Methods:At Shandong Cancer Hospital Affliated to Shandong University between March 1, 2012 and June 30, 2015, the sentinel lymph nodes (SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer. First, the SLNs were removed; then, the area surrounding the original SLNs was selected, and the visible lymph nodes in a ifeld of 3–5cm in diameter around the center (i.e., PLNs) were removed, avoiding damage to the structure of the breast. Finally, ALND was performed. The SLNs, PLNs, and remaining ALNs underwent pathologic examination, and the relationship between them was analyzed. Results:The identiifcation rate of SLNs in the 596 patients was 95.1% (567/596); the metastasis rate of ALNs was 33.7% (191/567); the FNR of pure SLNB was 9.9% (19/191); and after the SLNs and PLNs were eliminated, the FNR was 4.2% (8/191), which was signiifcantly decreased compared with the FNR before removal of PLNs (P=0.028). According to the detected number (N) of SLNs, the patients were divided into four groups of N=1, 2, 3, and≥4; the FNR in these groups was 19.6, 9.8, 7.3, and 2.3%, respectively. For the patients with≤2 or≤3 detected SLNs, the FNR after removal of PLNs was signiifcantly decreased compared with that before removal of PLNs (N≤2: 14.0% vs. 4.7%, P=0.019; N≤3: 12.2% vs. 4.7%,P=0.021), whereas for patients with≥4 detected SLNs, the decrease in FNR was not statistically signiifcant (P=1.000). In the entire cohorts, the “skip metastasis” rate was 2.5% (15/596); the FNR caused by “skip metastasis” was 2.1% (4/191). Conclusions:The FNR of SLNB was associated with the number of SLNs. For patients with≤3 detected SLNs, PLN sampling can reduce the FNR of SLNB to an acceptable level of less than 5%. Because of the existence of the “skip metastasis” and distinct metastasis patterns, the FNR of SLNB cannot be completely eliminated.     

Sentinel node biopsy in patients with multiple breast cancer

BACKGROUND: Multicentric or multifocal breast cancer is considered a limitation for sentinel lymph node biopsy (SLNB). Studies showing that all quadrants of the breast drain via common afferent lymphatic channels indicate that multiple tumors do not affect lymphatic drainage. We therefore assessed the accuracy of SLNB in patients with multiple breast tumors. METHODS: Of the 942 breast cancer patients who underwent SLNB using radioisotope at Asan Medical Center between January 2003 and December 2006, 803 had unifocal and 139 had multiple tumors. Axillary dissection after SLNB was performed on 884 patients, 757 with unifocal and 127 with multiple tumors. All patients underwent lymphatic scintigram for removal of sentinel lymph nodes (SLNs). The clinical characteristics and accuracy of SLNB was compared in patients with unifocal and multiple breast cancer. RESULTS: In the multiple tumor group, 2.68 +/- 0.84 SLNs were identified in 136 of 139 patients (identification rate, 97.84%); 81.5% of SLNs were identified by scintigram. The incidence of axillary metastases was 29.50% (41/139). SLNB accuracy was 97.63% (124/127), with a false negative (FN) rate of 7.89% (3/38). In the unifocal group, 2.67 +/- 0.96 SLNs were identified in 787 of 803 patients (identification rate, 98.00%); 84.8% of SLNs were identified by scintigram. The incidence of axillary metastasis was 22.04% (177/803). SLNB accuracy was 98.02% (742/757), with a FN rate of 8.62% (15/174). The accuracy and FN rate of SLNB did not differ significantly between unifocal and multiple breast cancer. CONCLUSION: The accuracy of SLNB in multiple breast cancer is comparable to its accuracy in unifocal cancer. These findings indicate that SLNB can be used an as alternative to complete axillary lymph node dissection in patients with multiple breast tumors.     

Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

BACKGROUND AND OBJECTIVES: Sentinel lymph node biopsy (SLNB) is an accurate method for axillary staging in patients with early breast cancer. The aim of this study was to evaluate the accuracy and the feasibility of SLNB in breast cancer patients who had received preoperative (neoadjuvant) chemotherapy. METHODS: Patients with advanced breast cancer stage II or III who were treated with neoadjuvant chemotherapy were included in the study. Sentinel lymph node (SLN) identification and biopsy was attempted and performed, and axillary lymph node dissection (ALND) was performed in the same surgical procedure after SLNB. The histopathologic examination of the SLNs and the dissected axillary lymph nodes was performed and nodal status was compared. RESULTS: Thirty patients were included in the study. After peritumoural injection of technetium-99m labelled human albumin and subareolar subcutaneous injection of blue dye, the SLNs could be identified in 26/30 patients (identification rate 86.7%). In 4/30 patients (13.3%) SLNs could not be identified. In 25/26 patients (96.2%) SLNs accurately predicted the axillary status. Eleven patients had negative SLNs and negative nodes in ALND. Six patients had positive SLNs and positive nodes in ALND. In eight patients SLNs only were positive and nodes in ALND were negative. One patient had a false-negative SLNB, calculating a false-negative rate of 6.7% (1/15). CONCLUSIONS: SLNB is a well introduced technique for axillary staging in patients with early breast cancer. The accuracy of SLNB after neoadjuvant chemotherapy is similar to patients with primary surgery. SLNB could be an alternative to ALND in a subgroup of patients after neoadjuvant chemotherapy, and therefore could reduce morbidity due to surgery in those patients. Due to small numbers of patients, further evaluation in this subset of patients is required.     

Sentinel lymph node biopsy after neoadjuvant chemotherapy

BACKGROUND: We surveyed single-center and multi-center studies pertaining to sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy to compare the results with those of our current study to evaluate the feasibility and accuracy of SLNB after neoadjuvant chemotherapy. METHODS: From October 2001 to July 2003, 80 patients who had neoadjuvant chemotherapy underwent curative surgery and axillary lymph node dissection (ALND) after SLNB at the Center for Breast Cancer, National Cancer Center. A MEDLINE search was performed using the keywords breast cancer, sentinel lymph node biopsy, and neoadjuvant chemotherapy. RESULTS: Our results showed that 42 (52.6%) of 80 patients had downstaging of the primary tumor; 9 patients (11.3%) had pathologic complete response (pCR) and 33 (41.3%) had pathologic partial response (pPR). 26 patients (32.5%) showed complete axillary clearance after neoadjuvant chemotherapy. Among them, 5 patients (6.3%) revealed pCR of both the primary tumor and axillary metastasis. SLNB was successful in 61 of 80 patients (76.3%) and there were 3 false negatives, yielding a false negative rate (FNR) of 7.3% (3/41), a negation prediction value (NPV) of 87.0%(20/23), and an accuracy of 95.1% (58/61). Thirteen out of 16 studies retrieved by to MEDLINE pertaining SLNB after neoadjuvant chemotherapy concluded its feasibility and accuracy with a identification rate of 82%-100% and a FNR of 17-100%. CONCLUSION: Most studies, including ours, concluded that SLNB after neoadjuvant chemotherapy is accurate and could be an alternative to ALND.     

乳腺癌新辅助化疗后前哨淋巴结活检术的研究进展

新辅助化疗（neoadjuvant chemotherapy,NAC）为乳腺癌患者的临床分期降期带来可能,使不可手术变为可手术,不可保乳变为可保乳。前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）极大降低了早期乳腺癌患者的腋窝淋巴结清扫（axillarylymph node dissection,ALND）率。目前,由于检出率较低而假阴性率较高,NAC后乳腺癌患者能否采用SLNB方法评估腋窝淋巴结状态仍有争议。本文将针对NAC后解决SLNB检出率低和假阴性率高的方法以及处理腋窝淋巴结等方面进行综述。      

Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer

Purpose

Near-infrared fluorescence imaging with indocyanine green (ICG) has the potential to improve sentinel lymph node (SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye with that of blue dye alone for detecting SLNs.

Methods

Patients undergoing SLN biopsy (SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected by using patent blue (PB) alone, and since January 2012, by using PB in combination with ICG. The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups. All patients underwent level I and II axillary dissections after SLNB.

Results

In group A, the SLN detection rate was 96.9% (93/96), the accuracy of detection was 98.9% (92/93), and the false-negative rate (FNR) was 3.4% (1/29). In group B, the SLN detection rate was 84.9% (62/73), the accuracy of detection was 96.8% (60/62), and the FNR was 11.1% (2/18). The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR.

Conclusion

The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.