Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India.
Department of Pathology, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India.
Breast Cancer Res Treat. 2022 May;193(1):105-110. doi: 10.1007/s10549-022-06556-w. Epub 2022 Mar 5.
Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical and a blue dye is gold standard for axillary staging in clinically node-negative breast cancer. High costs and limited availability of radio-pharmaceutical and/or gamma probe are major deterrents in performing SLNB in developing countries. In this study, we evaluated feasibility of SLN identification (SLN-IR) of fluorescein-guided (FG) SLNB in combination with methylene blue dye (MBD).
This was a prospective cross-sectional non-randomized validation study in patients with clinically node-negative axilla. Patients underwent validation SLNB using fluorescein (and blue LED light) and MBD. Axillary dissection was performed irrespective of SLNB histology. SLIN-IR and False Negative Rate (FNR) were assessed for both groups.
The SLNs were identified in 29 (96.6%) pre-chemotherapy patients and 23 (82%) post Neoadjuvant Chemotherapy (NACT) patients. The median number of sentinel lymph nodes identified was 3 (range of 1-5) in pre-chemotherapy patients and 1 (range of 1-3) in post NACT patients. The SLN-IR using MBD was 90%, FD was 86.7% and combined MBD FD was 96.7% in pre-chemotherapy patients. The SLN-IR using MBD was 82%, FD was 71% and combined MBD FD was 82% in in post NACT patients. The false negative rate (FNR) in pre-chemotherapy group was 8.0% (MBD), 8.3% (FD) and 7.4% (MBD + FD). The FNR in post NACT group was 8.7% (MBD), 10% (FD) and 8.7% (MBD + FD).
This prospective validation study showed adequate SLN-IR and FNR using low-cost dual dyes in early breast cancer patients and can be used in low resource settings. However, SLNB in post NACT axilla though viable along with a satisfactory FNR, is associated with low identification rate and needs further evaluation.
放射性药物和蓝色染料联合使用的前哨淋巴结活检（SLNB）是临床淋巴结阴性乳腺癌腋窝分期的金标准。在发展中国家，放射性药物和/或伽马探针的高成本和有限可用性是进行 SLNB 的主要障碍。在这项研究中，我们评估了荧光引导（FG）SLNB 联合亚甲蓝染料（MBD）进行 SLN 识别（SLN-IR）的可行性。
这是一项在临床淋巴结阴性腋窝的患者中进行的前瞻性、非随机验证性研究。患者接受荧光素（和蓝色 LED 光）和 MBD 验证性 SLNB。无论 SLNB 组织学如何，均进行腋窝解剖。评估了两组的 SLIN-IR 和假阴性率（FNR）。
在 29 例（96.6%）化疗前患者和 23 例（82%）新辅助化疗（NACT）后患者中识别出 SLN。化疗前患者的中位检出 SLN 数量为 3 个（范围为 1-5 个），NACT 后患者为 1 个（范围为 1-3 个）。在化疗前患者中，MBD 的 SLN-IR 为 90%，FD 为 86.7%，MBD+FD 的联合 SLN-IR 为 96.7%。在 NACT 后患者中，MBD 的 SLN-IR 为 82%，FD 为 71%，MBD+FD 的联合 SLN-IR 为 82%。化疗前组的假阴性率（FNR）为 8.0%（MBD）、8.3%（FD）和 7.4%（MBD+FD）。NACT 后组的 FNR 为 8.7%（MBD）、10%（FD）和 8.7%（MBD+FD）。
这项前瞻性验证性研究表明，在早期乳腺癌患者中使用低成本双染料可获得足够的 SLN-IR 和 FNR，并可在资源有限的环境中使用。然而，虽然 NACT 后腋窝的 SLNB 是可行的，且 FNR 令人满意，但它与低识别率相关，需要进一步评估。
