Efficiency of detection of lymph nodes in breast cancer

Abstract

The objective: improve the quality of sentinel lymph nodes detection in patients with malignant neoplasms of the mammary glands.Materials and methods. At the period from 2009 to 2016, 400 patients with T1-T3N0M0 breast cancer were operated in Odessa Regional Clinical Hospital, using two dyes Patent Blue and ICG.The patients who had mastectomy with sentinel lymph node biopsy were diagnosed T2-T3N0M0 breast cancer more frequently. The exceptions were T3-T4 tumors, tumor diameter > 5 cm, invasion into the skin and chest wall, palpable axillary lymph nodes, 3 or more affected lymph nodes during sentinel lymph node biopsy.100 patients in the first group had sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye.In the patients in the second group, sentinel lymph node biopsy was performed using Patent Blue dye and another fluorescent ICG dye, which was injected intravenously into the arm on the affected side of the mammary gland, along the outflow from the arm to the mammary gland.Results. The total five-year survival after axillary lymph node dissection and sentinel lymph node biopsy was 91 % and 92 %, respectively. The five-year recurrence-free survival after axillary lymph node dissection was approximately 82.2 %, and after the sentinel lymph node biopsy – 83.9 %. Regional recurrence in the sentinel lymph nodes on the affected side was determined only in 1.1 %. The time of observation of the patients was from 60 to 180 months. The recurrence was registered in 0.2 % patients as isolated metastases into the axillary lymph nodes. Not a single case of lymphostasis of the upper limbs from the side of the biopsy was registered. Conclusions. The simplicity of fluorescent dyes usage makes it possible to implement this method in the everyday work of oncologists-surgeons, the advantages of which are the absence of radiation exposure and quick intraoperative detection of lymph nodes.