Halilbasic Emir, Iljazovic Ermina, Mehmedovic Zlatan, Brkic Eldar, Sarkanovic Goran
Department of Plastic Surgery, University Clinical Center Tuzla. Tuzla, Bosnia and Herzegovina.
Department of Pathology, University Clinical Center Tuzla. Tuzla, Bosnia and Herzegovina.
Mater Sociomed. 2021 Dec;33(4):282-287. doi: 10.5455/msm.2021.33.282-287.
Invasive ductal cancer (IDC) represents about 75% of all breast malignancies. There are many breast cancer prognostic factors, but the ones that have the most impact on the survival rates in advanced breast cancer are tumor size and regional lymph node involvement. Axillary lymph node dissection (ALND) has particularly important and undoubtful role in current surgical options for breast cancer treatment. With the introduction of sentinel lymph node biopsy (SLNB) for breast cancer patients it was possible to identify those to whom regional spread of the disease did not occur at the time of surgery, and thus spare them an unnecessary ALND procedure.
To determine the rate of sentinel lymph node (SLN) detection using only methylene blue dye as a mapping agent, as well as to correlate the number of positive SLNs with the number of positive non-sentinel lymph nodes (non-SLNs).
The study represents a prospective study that included 50 female patients with histologically confirmed invasive ductal carcinoma (IDC) who underwent SLNB using only methylene blue dye as the mapping agent, while the detection and harvest of SNL was done by visual control only. All patients also underwent an obligatory complete ALND, which was as that time the institutional oncological protocol for surgical treatment of histologically confirmed IDC. The final data such as tumor size, SLN and non-SLN status were obtained by further analysis of pathohistological reports from tumor biopsy and other surgical specimens.
The accuracy rate of SLN detection was 98%. The number of detected SLN was in the range of 1 to 6, with an average of 2 for each patient. The number of positive SLN was in significant correlation with the number of tumor-affected non-SNL (p<0,001). Further analysis showed that for each increase in the number of positive SLN by 1, the risk of positive non-SLN increased 6-fold, OR=6,22 (p<0,001).
Use of methylene blue dye as a sole mapping agent when performing SLNB in patients with IDC is a reliable and effective method that can be safely implemented in medical institutions that lack availability of nuclear medicine services or significant monetary funds.
浸润性导管癌（IDC）约占所有乳腺恶性肿瘤的75%。乳腺癌有许多预后因素，但对晚期乳腺癌生存率影响最大的是肿瘤大小和区域淋巴结受累情况。腋窝淋巴结清扫术（ALND）在当前乳腺癌治疗的手术选择中具有特别重要且不容置疑的作用。随着乳腺癌患者前哨淋巴结活检（SLNB）的引入，可以识别出那些在手术时疾病未发生区域扩散的患者，从而避免他们接受不必要的ALND手术。
确定仅使用亚甲蓝染料作为定位剂时前哨淋巴结（SLN）的检测率，并将阳性SLN的数量与阳性非前哨淋巴结（非SLN）的数量相关联。
该研究为前瞻性研究，纳入了50例经组织学确诊为浸润性导管癌（IDC）的女性患者，她们仅使用亚甲蓝染料作为定位剂进行SLNB，而SLN的检测和获取仅通过视觉控制完成。所有患者还均接受了强制性的完整ALND，这在当时是该机构对组织学确诊的IDC进行手术治疗的肿瘤学方案。通过对肿瘤活检和其他手术标本的病理组织学报告进行进一步分析，获得了诸如肿瘤大小、SLN和非SLN状态等最终数据。
SLN检测的准确率为98%。检测到的SLN数量在1至6个之间，每位患者平均为2个。阳性SLN的数量与受肿瘤影响的非SLN数量显著相关（p<0.001）。进一步分析表明，阳性SLN数量每增加1个，非SLN为阳性的风险增加6倍，OR=6.22（p<0.001）。
在IDC患者中进行SLNB时，仅使用亚甲蓝染料作为定位剂是一种可靠且有效的方法，在缺乏核医学服务或大量资金的医疗机构中可以安全实施。
