Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
World J Surg Oncol. 2024 Aug 3;22(1):207. doi: 10.1186/s12957-024-03493-4.
Clinico-anatomical review and pilot studies demonstrated that intraparenchymal injection at any site, even those not containing the index lesion, or periareolar injections should provide concordant outcomes to peritumoral injections.
This was a single-center retrospective cohort at King Chulalongkorn Memorial Hospital. The electronic medical records of patients were characterized into conventional and new injection concept groups. The inclusion criteria were patients who had either a mastectomy or BCS along with SLNB. We excluded patients who underwent ALND, received neoadjuvant therapy, or had non-invasive breast cancer. The primary outcome was the 5-year rate of breast cancer regional recurrence. Additionally, we reported on the re-operation rate, disease-free period, distant disease-free period, mortality rate, and recurrence rates both locoregional and systemic. Recurrences were identified through clinical assessments and imaging.
3 ml of 1%isosulfan blue dye was injected, with the injection site varying according to the specific concept being applied. In cases of SSM and NSM following the new concept, the blue dye was injected at non-periareolar and non-peritumoral sites. After the injection, a 10-minute interval was observed without massaging the injection site. Following this interval, an incision was made to access the SLNs, which were subsequently identified, excised, and sent for either frozen section analysis or permanent section examination.
There were no significant differences in DFS, DDFS or BCSS between the two groups (p = 0.832, 0.712, 0.157). Although the re-operation rate in the NI group was approximately half that of the CI group, this difference was not statistically significant (p = 0.355).
Our study suggests that tailoring isosulfan blue dye injection site based on operation type rather than tumor location is safe and effective approach for SLN localization in early-stage breast cancer. However, this study has limitations, including being a single-center study with low recurrence and death cases. Future studies should aim to increase the sample size and follow-up period.
临床解剖学回顾和试点研究表明，在任何部位进行脑实质内注射，甚至那些不包含病灶的部位或乳晕周围注射，都应能提供与肿瘤周围注射一致的结果。
这是一项在朱拉隆功国王纪念医院进行的单中心回顾性队列研究。患者的电子病历被分为常规和新注射概念两组。纳入标准为接受乳房切除术或保乳手术联合前哨淋巴结活检的患者。我们排除了接受腋窝淋巴结清扫术、接受新辅助治疗或患有非浸润性乳腺癌的患者。主要结局是 5 年乳腺癌区域复发率。此外，我们还报告了再手术率、无病生存期、无远处疾病生存期、死亡率以及局部和全身复发率。复发通过临床评估和影像学确定。
注射 3 毫升 1%异硫蓝染料，注射部位根据应用的具体概念而变化。在新概念下的 SSM 和 NSM 中，蓝染剂注射在非乳晕和非肿瘤周围部位。注射后观察 10 分钟，不按摩注射部位。间隔 10 分钟后，做一个切口以获取前哨淋巴结，然后识别、切除并进行冷冻切片分析或永久切片检查。
两组在无病生存期、无远处疾病无病生存期或乳腺癌特异性生存期方面无显著差异（p=0.832、0.712、0.157）。尽管 NI 组的再手术率约为 CI 组的一半，但差异无统计学意义（p=0.355）。
我们的研究表明，根据手术类型而不是肿瘤位置定制异硫蓝染料注射部位是一种安全有效的早期乳腺癌前哨淋巴结定位方法。然而，本研究存在局限性，包括这是一项单中心研究，复发和死亡病例较少。未来的研究应旨在增加样本量和随访时间。
