Foster Deshka, Choy Nicole, Porter Catherine, Ahmed Shushmita, Wapnir Irene
Department of Surgery, Stanford University School of Medicine, Stanford, California.
J Surg Oncol. 2018 Mar;117(3):336-340. doi: 10.1002/jso.24859. Epub 2017 Dec 11.
Sentinel lymph node (SLN) resection is imperative for breast cancer staging. Axillary reverse mapping (ARM) can preserve arm draining nodes and lymphatics during surgery. ARM is generally performed with isosulfan blue (ISB), restricting its use for concurrent SLN biopsy. Indocyanine green (ICG) could serve as an alternative to ISB for ARM procedures.
SLN mapping and biopsy was performed via periareolar injection of technetium-sulfur colloid ( TcSc, TSC). ISB and ICG were injected in the upper arm. Blue-stained lymphatics or nodes were visualized in the axilla; ICG was identified using the SPY Elite® system.
Twenty-three patients underwent SLN biopsy with or without axillary node dissection and ARM procedures. Twenty of these patients had at least one hot node; 12 patients had SLNs that were only hot, 6 hot/blue/fluorescent, and 2 hot/fluorescent. Overall, crossover of ARM agents with SLNs occurred in 8 cases. Inspection of the axillary cavity after SLN biopsy revealed fluorescent lymphatics and nodes remaining in 14 and 7 patients, respectively. Blue lymphatics and blue nodes were detected in fewer cases.
Nearly one-third of patients showed crossover between breast and arm draining nodes, which provides insight as to why some patients develop lymphedema symptoms after SLN biopsy. ICG and ISB identify similar numbers of SLNs. As such ICG could substitute for ISB in ARM procedures.
前哨淋巴结（SLN）切除对于乳腺癌分期至关重要。腋窝反向造影（ARM）可在手术期间保留手臂引流淋巴结和淋巴管。ARM通常使用异硫蓝（ISB）进行，这限制了其在同期SLN活检中的应用。吲哚菁绿（ICG）可作为ARM手术中ISB的替代物。
通过乳晕周围注射锝硫胶体（TcSc，TSC）进行SLN造影和活检。将ISB和ICG注射到上臂。在腋窝中观察蓝色染色的淋巴管或淋巴结；使用SPY Elite®系统识别ICG。
23例患者接受了SLN活检，伴或不伴有腋窝淋巴结清扫及ARM手术。其中20例患者至少有一个热结节；12例患者的SLN仅为热结节，6例为热/蓝/荧光结节，2例为热/荧光结节。总体而言，ARM剂与SLN交叉出现8例。SLN活检后检查腋窝腔发现，分别有14例和7例患者残留荧光淋巴管和淋巴结。检测到蓝色淋巴管和蓝色淋巴结的病例较少。
近三分之一的患者显示乳腺和手臂引流淋巴结之间存在交叉，这为一些患者在SLN活检后出现淋巴水肿症状的原因提供了见解。ICG和ISB识别出的SLN数量相似。因此，ICG可在ARM手术中替代ISB。
