Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
World J Surg. 2020 Oct;44(10):3417-3422. doi: 10.1007/s00268-020-05631-x.
Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical (RP) and a blue dye is gold standard for axillary staging in clinically node-negative early breast cancer. High costs and limited availability of RP and/or gamma probe are major deterrents in performing SLNB in developing countries. Fluorescence-guided SLNB can obviate the need for RP and gamma probe. Fluorescein is an inexpensive fluorescent lymphatic tracer. In this study, we compared SLN identification rate (SLN-IR) and false negative rates (FNR) of fluorescein-guided SLNB and radio-guided SLNB using Tc-Sulfur-colloid, in isolation, or in combination with methylene blue dye (MBD).
Sixty-five cN0 early and large operable breast cancer patients underwent validation SLNB using fluorescein (and blue LED light), Tc-Sulfur-colloid (and gamma probe) and MBD. Inj Fluorescein 4% was injected, 1 ml each peri-tumoral and sub-areolar five minutes before axillary incision. Axillary dissection was performed irrespective of SLNB histology. The SLN-IR and FNR with various tracers and their combinations were compared.
The mean number of SLNs identified was 3.5 ± 1.8 (range 1-6). The SLN-IR using RP alone was 94%, fluorescein alone was 92%, and MBD alone was 82%. The SLN-IR using fluorescein plus MBD combination was 95.4%, compared to 97% using MBD plus RP combination. FNR was 6.3% using fluorescein plus MBD, as well as RP plus MBD combinations.
SLN-IR of > 90% and SLN-FNR of < 10% using fluorescein plus MBD combination are in acceptable range, and are comparable to that of RP plus MBD combination. Fluorescein can replace RP for performing SLNB, in combination with MBD.
放射性核素（RP）和蓝色染料联合的前哨淋巴结活检（SLNB）是临床淋巴结阴性早期乳腺癌腋窝分期的金标准。在发展中国家，由于 RP 和/或伽马探测仪的高成本和有限供应，SLNB 的开展受到了很大的阻碍。荧光引导的 SLNB 可以避免对 RP 和伽马探测仪的需求。荧光素是一种廉价的荧光淋巴管示踪剂。在这项研究中，我们比较了单独使用荧光素和单独或联合使用锝-硫胶体（Tc-硫胶体）、亚甲蓝染料（MBD）引导的 SLNB 的前哨淋巴结识别率（SLN-IR）和假阴性率（FNR）。
65 例 cN0 早期可手术的乳腺癌患者接受了验证性 SLNB，使用荧光素（和蓝色 LED 光）、Tc-硫胶体（和伽马探测仪）和 MBD。在腋窝切口前 5 分钟，每侧肿瘤周围和乳晕下注射 1ml 4%荧光素。无论 SLNB 组织学如何，均进行腋窝清扫。比较了各种示踪剂及其组合的 SLN-IR 和 FNR。
平均识别的前哨淋巴结数为 3.5±1.8（范围 1-6）。单独使用 RP 的 SLN-IR 为 94%，单独使用荧光素为 92%，单独使用 MBD 为 82%。荧光素联合 MBD 的 SLN-IR 为 95.4%，而 MBD 联合 RP 的 SLN-IR 为 97%。荧光素联合 MBD 以及 RP 联合 MBD 的 FNR 均为 6.3%。
使用荧光素联合 MBD 的 SLN-IR>90%和 SLN-FNR<10%在可接受范围内，与 RP 联合 MBD 组合相当。荧光素可以替代 RP 与 MBD 联合用于 SLNB。
