Bozhok A A, Zikiryakhodzhaev A D, Kvetenadze G E, Moshurova M V, Timoshkin V O, Shomova M V, Manelov A E
Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia.
North-Western District Scientific and Clinical Center named after L.G. Sokolov of the Federal Medical and Biological Agency, St. Petersburg, Russia.
Khirurgiia (Mosk). 2024(10):49-61. doi: 10.17116/hirurgia202410149.
To study the diagnostic value of fluorescent lymphography for sentinel lymph node biopsy in breast cancer.
The cohort study, conducted at 4 specilized centers between June 2019 and March 2024, included 333 patients with cT1-4 N0-1M0 breast cancer. 50 patients received neoadjuvant systemic therapy, 14 of them had single metastases, confirmed by cytological or histological methods, which clinically completely regressed after systemic treatment. Immediately before the operation, 1 ml (5mg) of indocyanine green was injected subareolarly or subcutaneously into the tumor projection. Fluorescence imaging was performed using various devices for ICG navigation in the open surgical field - MARS, IC-Flow, Stryker SPY-PHI, IC-GOR. In 78 patients after sentinel lymph node biopsy standard axillary lymphadenectomy was performed.
Detection level was 99.1%. The average number of sentinel lymph nodes was 3.4. Metastatic lesions of sentinel lymph nodes were detected in 54 of 330 patients (16.4%). The average number of metastatic lymph nodes was 1.6; in 90.7% of cases metastases to 1-2 lymph nodes were registered. Intraoperative morphological examination revealed metastases only in 59% of cases. No systemic adverse events were recorded. The false-negative error rate in the group of patients who underwent axillary lymphadenectomy was 6.6%. The overall accuracy of fluorescent lymphography for sentinel lymph node biopsy in breast cancer was 94%.
The SLNB technique using fluorescence lymphography is safe and highly accurate as a stand-alone method.
研究荧光淋巴造影术在乳腺癌前哨淋巴结活检中的诊断价值。
该队列研究于2019年6月至2024年3月在4个专业中心进行，纳入了333例cT1-4 N0-1M0乳腺癌患者。50例患者接受了新辅助全身治疗，其中14例有单发转移，经细胞学或组织学方法确诊，全身治疗后临床完全缓解。手术前即刻，将1毫升（5毫克）吲哚菁绿乳晕下或皮下注射到肿瘤投影部位。在开放手术视野中使用各种用于吲哚菁绿导航的设备进行荧光成像——MARS、IC-Flow、史赛克SPY-PHI、IC-GOR。78例患者在前哨淋巴结活检后进行了标准腋窝淋巴结清扫术。
检测率为99.1%。前哨淋巴结的平均数量为3.4个。330例患者中有54例（16.4%）检测到前哨淋巴结转移病变。转移淋巴结的平均数量为1.6个；90.7%的病例转移至1-2个淋巴结。术中形态学检查仅在59%的病例中发现转移。未记录到全身不良事件。接受腋窝淋巴结清扫术的患者组假阴性错误率为6.6%。荧光淋巴造影术在乳腺癌前哨淋巴结活检中的总体准确率为94%。
使用荧光淋巴造影术的前哨淋巴结活检技术作为一种独立方法是安全且高度准确的。
