Department of Gynecology and Obstetrics, Clinical Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil.
Division of Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil.
J Surg Oncol. 2020 Aug;122(2):164-169. doi: 10.1002/jso.25928. Epub 2020 Apr 14.
Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate.
A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected.
Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02).
The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.
在新辅助化疗（NAC）前标记阳性淋巴结（LNs）可能会提高前哨淋巴结活检（SLNB）的准确性。本研究旨在确定在 NAC 前用 4%碳微球混悬液（CMS）标记 LNs 的可行性，并评估该技术是否会提高 SLNB 检出率。
前瞻性研究了 123 例接受超声引导细针抽吸活检（FNAB）可疑 LNs 并同时用 4%CMS 进行标记的 cT1-T4、cN1-N2 乳腺癌患者。NAC 后，对用 4%CMS 标记的 LNs 和用专利蓝 V 染料（PBV）标记的 LNs 进行识别和切除。
123 例患者中，74 例（60.1%）FNAB 显示阳性 LNs。在腋窝手术中，123 例患者中有 121 例（98.3%）发现 4%CMS，91%（112 例）发现蓝色前哨 LNs（P = .0103）。比较 PBV 和 4%CMS+PBV 的单独结果，在识别阳性 LNs 方面，两者的相关性更好（72.2%比 97.7%）（P = .02）。
4%CMS 和 PBV 的联合使用是可行的，显著提高了阳性 LNs 的检出率。4%CMS 可能在接受 NAC 的患者中作为一种补充技术发挥重要作用。
