Comparison between indocyanine green fluorescence imaging plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Teng , MAO Yan , ZHENG Shuai ,  WANG Haibo

Center of Diagnosis and Treatment of Breast Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P. R. China;

Corresponding author：

WANG Haibo, Email: hbwan966@126.com

Keywords：

breast cancer; indocyanine green; radioactive nuclide; sentinel lymph node biopsy; neoadjuvant chemotherapy

DOI：

10.7507/1007-9424.201904045

Video：

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Objective To investigate the differences between indocyanine green (ICG) plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy (SLNB) after Neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods A total of 77 breast cancer patients who accepted SLNB and axillary lymph node dissection (ALND) after NAC from June 2017 to February 2019 were involved, among them, 46 breast cancer patients accepted SLNB by ICG plus methylene blue and 31 breast cancer patients accepted SLNB by radioactive nuclide plus methylene blue, pathological and clinical data were collected and analyzed.Results There were 43 patients in the ICG plus methylene blue group and 30 patients in radioactive nuclide plus methylene blue group, which totally 73 patients were detected at least one sentinel lymph node in all the 77 patients, and the detection rate was 94.80%. The SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy of the ICG plus methylene blue group were 93.48% (43/46), 2.32 per case, 82.61% (19/23), 17.39% (4/23), and 90.70% (39/43) respectively, as well as 96.77% (30/31), 2.6 per case, 83.33% (10/12), 16.67% (2/10), and 93.33% (28/30) in the radioactive nuclide plus methylene blue group. There was no significant difference between the ICG plus methylene blue group and radioactive nuclide plus methylene blue group in terms of SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy (P>0.05).Conclusion ICG plus methylene blue showed similar SLN detection rate, SLN detected numbers, sensitivity, false negative rate, and accuracy as radioactive nuclide plus methylene blue for SLNB in breast cancer patients after NAC, and both of them can be performed easily and conveniently.

Citation： MA Teng, MAO Yan, ZHENG Shuai, WANG Haibo. Comparison between indocyanine green fluorescence imaging plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(9): 1046-1050. doi: 10.7507/1007-9424.201904045 Copy

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2.	Miller E, Lee HJ, Lulla A, et al. Current treatment of early breast cancer: adjuvant and neoadjuvant therapy. F1000Res, 2014, 3: 198.
3.	Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol, 2012, 30(32): 3960-3966.
4.	Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
5.	牟鹏, 厉红元. 乳腺癌新辅助化疗的研究进展. 中国普外基础与临床杂志, 2011, 18(9): 1011-1016.
6.	Dodwell D. Timing of sentinel lymph node biopsy in breast cancer patients receiving neoadjuvant chemotherapy. Eur J Surg Oncol, 2013, 39(11): 1298.
7.	Kumar A, Puri R, Gadgil PV, et al. Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg, 2012, 36(7): 1453-1459.
8.	Chang JM, Kosiorek HE, Wasif N, et al. The success of sentinel lymph node biopsy after neoadjuvant therapy: a single institution review. Am J Surg, 2017, 214(6): 1096-1101.
9.	Hojo T, Nagao T, Kikuyama M, et al. Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer. Breast, 2010, 19(3): 210-213.
10.	Curigliano G, Burstein HJ, P Winer E, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2017, 28(8): 1700-1712.
11.	Gradishar WJ, Anderson BO, Balassanian R, et al. Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(3): 310-320.
12.	Yagata H, Yamauchi H, Tsugawa K, et al. Sentinel node biopsy after neoadjuvant chemotherapy in cytologically proven node-positive breast cancer. Clin Breast Cancer, 2013, 13(6): 471-477.
13.	Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol, 2015, 33(3): 258-264.
14.	Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA, 2013, 310(14): 1455-1461.
15.	杨涛, 王永胜. 乳腺癌新辅助化疗后局部区域外科处理进展. 中国普外基础与临床杂志, 2014, 21(5): 583-588.
16.	Zhang GC, Liao N, Guo ZB, et al. Accuracy and axilla sparing potentials of sentinel lymph node biopsy with methylene blue alone performed before versus after neoadjuvant chemotherapy in breast cancer: a single institution experience. Clin Transl Oncol, 2013, 15(1): 79-84.
17.	Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early stage breast cancer: American Society of CIinical Oncology clinical practice guideline update. J Clin Oncol, 2014, 32(13): 1365-1383.
18.	郑刚, 杨靖, 左文述, 等. 中国乳腺癌前哨淋巴结活检验证阶段研究结果的系统评价. 中华医学杂志, 2011, 91(6): 361-365.
19.	Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol, 2013, 14(7): 609-618.
20.	王新华, 古力努尔·哈布力哈吉, 董占飞, 等. ^99mTc-硫胶体术前淋巴显像在乳腺癌前哨淋巴结活检中的应用. 中国肿瘤临床, 2010, 37(21): 1227-1231.
21.	van der Vorst JR, Schaafsma BE, Verbeek FP, et al. Randomized comparison of near-infrared fluorescence imaging using indocyanine green and ^99mtechnetium with or without patent blue for the sentinel lymph node procedure in breast cancer patients. Ann Surg Oncol, 2012, 19(13): 4104-4111.
22.	龚晓军, 毛红岩, 刘慧民, 等. 吲哚菁绿荧光法在乳腺癌前哨淋巴结活检中的应用. 中国普外基础与临床杂志, 2016, 23(2): 221-224.
23.	Aoyama K, Kamio T, Ohchi T, et al. Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green. World J Surg Oncol, 2011, 9(1): 157.
24.	Ballardini B, Santoro L, Sangalli C, et al. The indocyanine green method is equivalent to the ^99mTc-labeled radiotracer method for identifying the sentinel node in breast cancer: a concordance and validation study. Europ J Surg Oncol, 2013, 39(12): 1332-1336.
25.	Stoffels I, Dissemond J, Pöppel T, et al. Intraoperative fluorescence imaging for sentinel lymph node detection: prospective clinical trial to compare the usefulness of indocyanine green vs technetium Tc^99m for identification of sentinel lymph nodes. JAMA Surg, 2015, 150(7): 617-623.
26.	曹迎明, 王殊, 郭嘉嘉, 等. 吲哚菁绿联合美蓝在乳腺癌前哨淋巴结活检术中的应用. 中华普通外科杂志, 2014, 29(2): 119-122.

1. Krug D. Prognostic factors for locoregional recurrence after neoadjuvant chemotherapy. Results of a combined analysis from NSABP B-18 and B-27. Strahlenther Onkol, 2013, 189(7): 594-595.
2. Miller E, Lee HJ, Lulla A, et al. Current treatment of early breast cancer: adjuvant and neoadjuvant therapy. F1000Res, 2014, 3: 198.
3. Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol, 2012, 30(32): 3960-3966.
4. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
5. 牟鹏, 厉红元. 乳腺癌新辅助化疗的研究进展. 中国普外基础与临床杂志, 2011, 18(9): 1011-1016.
6. Dodwell D. Timing of sentinel lymph node biopsy in breast cancer patients receiving neoadjuvant chemotherapy. Eur J Surg Oncol, 2013, 39(11): 1298.
7. Kumar A, Puri R, Gadgil PV, et al. Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg, 2012, 36(7): 1453-1459.
8. Chang JM, Kosiorek HE, Wasif N, et al. The success of sentinel lymph node biopsy after neoadjuvant therapy: a single institution review. Am J Surg, 2017, 214(6): 1096-1101.
9. Hojo T, Nagao T, Kikuyama M, et al. Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer. Breast, 2010, 19(3): 210-213.
10. Curigliano G, Burstein HJ, P Winer E, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2017, 28(8): 1700-1712.
11. Gradishar WJ, Anderson BO, Balassanian R, et al. Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(3): 310-320.
12. Yagata H, Yamauchi H, Tsugawa K, et al. Sentinel node biopsy after neoadjuvant chemotherapy in cytologically proven node-positive breast cancer. Clin Breast Cancer, 2013, 13(6): 471-477.
13. Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol, 2015, 33(3): 258-264.
14. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA, 2013, 310(14): 1455-1461.
15. 杨涛, 王永胜. 乳腺癌新辅助化疗后局部区域外科处理进展. 中国普外基础与临床杂志, 2014, 21(5): 583-588.
16. Zhang GC, Liao N, Guo ZB, et al. Accuracy and axilla sparing potentials of sentinel lymph node biopsy with methylene blue alone performed before versus after neoadjuvant chemotherapy in breast cancer: a single institution experience. Clin Transl Oncol, 2013, 15(1): 79-84.
17. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early stage breast cancer: American Society of CIinical Oncology clinical practice guideline update. J Clin Oncol, 2014, 32(13): 1365-1383.
18. 郑刚, 杨靖, 左文述, 等. 中国乳腺癌前哨淋巴结活检验证阶段研究结果的系统评价. 中华医学杂志, 2011, 91(6): 361-365.
19. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol, 2013, 14(7): 609-618.
20. 王新华, 古力努尔·哈布力哈吉, 董占飞, 等. ^99mTc-硫胶体术前淋巴显像在乳腺癌前哨淋巴结活检中的应用. 中国肿瘤临床, 2010, 37(21): 1227-1231.
21. van der Vorst JR, Schaafsma BE, Verbeek FP, et al. Randomized comparison of near-infrared fluorescence imaging using indocyanine green and ^99mtechnetium with or without patent blue for the sentinel lymph node procedure in breast cancer patients. Ann Surg Oncol, 2012, 19(13): 4104-4111.
22. 龚晓军, 毛红岩, 刘慧民, 等. 吲哚菁绿荧光法在乳腺癌前哨淋巴结活检中的应用. 中国普外基础与临床杂志, 2016, 23(2): 221-224.
23. Aoyama K, Kamio T, Ohchi T, et al. Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green. World J Surg Oncol, 2011, 9(1): 157.
24. Ballardini B, Santoro L, Sangalli C, et al. The indocyanine green method is equivalent to the ^99mTc-labeled radiotracer method for identifying the sentinel node in breast cancer: a concordance and validation study. Europ J Surg Oncol, 2013, 39(12): 1332-1336.
25. Stoffels I, Dissemond J, Pöppel T, et al. Intraoperative fluorescence imaging for sentinel lymph node detection: prospective clinical trial to compare the usefulness of indocyanine green vs technetium Tc^99m for identification of sentinel lymph nodes. JAMA Surg, 2015, 150(7): 617-623.
26. 曹迎明, 王殊, 郭嘉嘉, 等. 吲哚菁绿联合美蓝在乳腺癌前哨淋巴结活检术中的应用. 中华普通外科杂志, 2014, 29(2): 119-122.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison between indocyanine green fluorescence imaging plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients

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