Breast Center, Department of Thyroid-Breast-Hernia Surgery, Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dongcheng District, Beijing, 100730, People's Republic of China.
World J Surg Oncol. 2023 Jul 21;21(1):214. doi: 10.1186/s12957-023-03120-8.
This study aimed to evaluate the feasibility of applying carbon nanoparticles (CNs) to visualize clip-marked metastatic nodes in combination with indocyanine green (ICG) and methylene blue (MB) as sentinel lymph node (SLN) tracers for targeted axillary dissection (TAD) after neoadjuvant therapy (NAT).
This feasibility trial enrolled 40 patients with node-positive breast cancer, and 38 patients completed NAT and surgery were included in the final analysis. Before NAT or surgery, clip-marked nodes were localized with CNs by ultrasonography. After NAT, the clip-marked nodes were removed under the guidance of carbon-tattooing and confirmed by radiography. SLNs were mapped with ICG and MB. Axillary lymph node dissection (ALND) was performed for all patients after TAD.
The clip-marked nodes were retrieved in all patients. The SLN identification rate was 100%. 29 of 38 clipped-nodes were SLNs. The false-negative rate was 6.25% (2/32,95% CI:1.09% ~ 22.22%) for TAD nodes and 9.38% (3/32,95% CI 3.24%-24.22%) for SLNs, and 18.75% for clipped-nodes (6/32, 95% CI:7.86% ~ 37.04%). No adverse events were reported during clip placement, CNs localization, or the TAD procedure.
The TAD procedure with CNs to locate and visualize clipped nodes as well as SLN tracing with ICG and MB has good accessibility in China, and this technique could be easily mastered by experienced surgeons. The modified TAD technique has also demonstrated good predictive ability for residual axillary lesions after NAT, and is worth of further evaluation.
本研究旨在评估将碳纳米粒子（CNs）应用于可视化夹标记的转移性淋巴结的可行性，结合吲哚菁绿（ICG）和亚甲蓝（MB）作为新辅助治疗（NAT）后前哨淋巴结活检（SLNB）的示踪剂，进行靶向腋窝清扫（TAD）。
本可行性试验纳入了 40 例淋巴结阳性乳腺癌患者，其中 38 例患者完成了 NAT 和手术，最终分析纳入了这 38 例患者。在 NAT 之前或手术之前，通过超声对夹标记的节点进行定位。NAT 后，在碳纹身的引导下切除夹标记的节点，并通过 X 线摄影确认。用 ICG 和 MB 标记 SLN。所有患者在 TAD 后均行腋窝淋巴结清扫（ALND）。
所有患者均成功取出夹标记的节点。SLN 的检出率为 100%。38 个夹标记的节点中，有 29 个为 SLN。TAD 节点的假阴性率为 6.25%（2/32，95%CI：1.09%22.22%），SLN 的假阴性率为 9.38%（3/32，95%CI 3.24%24.22%），夹标记的节点的假阴性率为 18.75%（6/32，95%CI：7.86%~37.04%）。在夹放置、CNs 定位或 TAD 过程中均未报告不良事件。
在中国，使用 CNs 定位和可视化夹标记的节点以及 ICG 和 MB 标记 SLN 的 TAD 程序具有良好的可及性，并且该技术可以被经验丰富的外科医生轻松掌握。改良的 TAD 技术也显示出对 NAT 后残留腋窝病变的良好预测能力，值得进一步评估。
