Diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer. Summary experience of several specialized centers

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OBJECTIVE

To study the diagnostic value of fluorescent lymphography for sentinel lymph node biopsy in breast cancer.

MATERIAL AND METHODS

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.

RESULTS

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%.

CONCLUSION

The SLNB technique using fluorescence lymphography is safe and highly accurate as a stand-alone method.

Keywords:

breast cancer

sentinel lymph nodes biopsy

indocyanine green

Authors:

Bozhok A.A.

Saint-Petersburg State Pediatric Medical University;
North-Western District Scientific and Clinical Center named after L.G. Sokolov of the Federal Medical and Biological Agency

ORCID: 0000-0002-1187-7989

Zikiryakhodzhaev A.D.

P. Hertsen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian Federation;
People’s Friendship University of Russia, Moscow, Russia (RUDN University);
I.M. Sechenov First Moscow State Medical University (Sechenov University)

SPIN RSCI: 8421-0364
Scopus AuthorID: 57220129122
ORCID: 0000-0001-7141-2502

Kvetenadze G.E.

The Loginov Moscow Clinical Scientific Center Moscow Health Department

ORCID: 0000-0003-1002-2548

Moshurova M.V.

P. Hertsen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian Federation

ORCID: 0000-0003-4141-8414

Timoshkin V.O.

P. Hertsen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian Federation

ORCID: 0000-0002-2490-9353

Shomova M.V.

Regional Clinical Oncological Dispensary;
Ryazan State Medical University

ORCID: 0000-0002-6235-0925

Manelov A.E.

North-Western State Medical University named after I.I. Mechnikov

ORCID: 0009-0009-7892-4768

Received:

21.07.2024

Accepted:

10.08.2024

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