Pellini Francesca, Bertoldi Lorenzo, Deguidi Giulia, Perusi Nicola, Caldana Marina, De Flaviis Mattia, Di Paolo Serena, Mirandola Sara, Tombolan Valeria, Zambelli Sopalu Sabrina, Invento Alessandra
Complex Operative Unit (UOC) Breast Surgery, Breast Unit, Oncology Department Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy.
Gland Surg. 2022 Jul;11(7):1139-1147. doi: 10.21037/gs-21-609.
Sentinel lymph node biopsy (SLNB) is now considered the "gold standard" for axillary staging in the treatment of breast cancer. Most of the lymph node mapping experiences have been performed with a radioisotope (albumin-Tc99m) associated or not with the intraoperative injection of a dye, such as Patent-Blue V. Recent studies have shown how the use of indocyanine green (ICG; a drug used for diagnostic use for many years in other sectors) as a fluorescent tracer, allows to obtain alone detection rate of the sentinel lymph node similar or even better, without the risks related to radioactivity and with better use of resources.
From March 2020 to February 2021, 184 patients with breast cancer cN0, candidate for SLNB were enrolled at the Complex Operative Unit (UOC) of Breast Surgery, Breast Unit of the Hospital of Verona. The ICG was injected into the periareolar site and was used the NOVADAQ SPY Elite system (Stryker) for transcutaneous intraoperative observation of fluorescence. The primary objective of the study is the evaluation of the feasibility of the technique and its sensitivity in the identification of sentinel lymph node; among the secondary endpoints the recognition of predictive factors on the identification (t1-t0) and extraction (t2-t1) times of the sentinel lymph node, and on the number of lymph node uptake pathways. Finally, was analyse the safety of the technique.
The sentinel lymph node was detected and removed in 98.3%. The average number of sentinel lymph nodes extracted is 1.527, while the average number of total lymph nodes (TLNs) extracted is 3.375. The sensitivity of the sentinel lymph node detection technique with ICG, turns out to be 100%. Finally, in the literature, lymphatic function decreases with increasing age, reducing the identification rate of the SLN; this is not confirmed in our study.
Our study confirms the use of the only ICG tracer for SLNB in cN0 breast cancer, demonstrating that it is a safe, effective and sensitive technique, which also allows to reduce costs, risks and organizational efforts.
前哨淋巴结活检（SLNB）目前被认为是乳腺癌腋窝分期的“金标准”。大多数淋巴结定位经验是通过放射性同位素（白蛋白 - Tc99m）进行的，其与术中注射染料（如专利蓝V）相关或不相关。最近的研究表明，使用吲哚菁绿（ICG；一种在其他领域已用于诊断多年的药物）作为荧光示踪剂，能够单独获得相似甚至更好的前哨淋巴结检出率，且无放射性相关风险，资源利用更优。
2020年3月至2021年2月，184例cN0期乳腺癌且适合进行前哨淋巴结活检的患者在维罗纳医院乳腺外科综合手术单元（UOC）入组。将ICG注入乳晕周围部位，并使用NOVADAQ SPY Elite系统（史赛克公司）进行术中经皮荧光观察。本研究的主要目的是评估该技术的可行性及其在前哨淋巴结识别中的敏感性；次要终点包括识别前哨淋巴结识别（t1 - t0）和提取（t2 - t1）时间以及淋巴结摄取途径数量的预测因素。最后，分析该技术的安全性。
前哨淋巴结的检出和切除率为98.3%。提取的前哨淋巴结平均数量为1.527个，而提取的总淋巴结（TLNs）平均数量为3.375个。ICG前哨淋巴结检测技术的敏感性为100%。最后，文献中提到淋巴功能随年龄增长而下降，导致前哨淋巴结识别率降低；但在我们的研究中未得到证实。
我们的研究证实了在cN0期乳腺癌的前哨淋巴结活检中仅使用ICG示踪剂，表明它是一种安全、有效且敏感的技术，还能降低成本、风险和组织工作负担。
