Precise intraoperative sentinel lymph node biopsies guided by lymphatic drainage in breast cancer

Xiaoyan Li, Sisi Chen, Liyu Jiang, Xiaoli Kong, Tingting Ma, Hong Xu, Qifeng Yang, Xiaoyan Li, Sisi Chen, Liyu Jiang, Xiaoli Kong, Tingting Ma, Hong Xu, Qifeng Yang

Abstract

The purpose of this study was to present a novel surgical method for intraoperative precise sentinel lymph node biopsy (SLNB) and to determine its clinical efficacy and sensitivity in breast cancer patients. The sentinel lymph nodes (SLNs) were preoperatively evaluated by axillary ultrasound. The intraoperative detection of SLNs was guided by lymphatic drainage pathway. The lymphatic vessels and SLNs were visualized. During operation, we searched for all the true SLNs (trSLNs), para-SLNs (paSLNs) and post-SLNs (poSLNs) followed lymphatic drainage ducts. After precisely locating the lymphatic channels and lymph node, all the lymph nodes that firstly receive lymphatic drainage are designated as trSLNs. We precisely distinguished the trSLNs, paSLNs and poSLNs. We found the average number of trSLNs ranged from1 to 6. In addition, we assessed the novel technique in a total of 125 breast cancer patients. trSLNs were successfully identified in all patients (detection rate: 100 %). The accuracy of trSLNs is 99.2%. Data from our study strongly suggest that our method is a feasible and effective for the detection of precise trSLNs in breast cancer with real-time observations. (ClinicalTrials.gov number, NCT02651142).

Keywords: breast cancer; precise sentinel lymph node biopsy; trSLNs.

Conflict of interest statement

CONFLICTS OF INTEREST The authors declare no conflicts of interest.

Figures

Figure 1. Marking the whole lymphatic vessels…
Figure 1. Marking the whole lymphatic vessels guided by ICG fluorescence
(A) The indocyanine green fluorescence real-time dynamic imaging system. Black arrows were the possible SLNs under preoperatively axillary ultrasound assessment. (B) ICG fluorescence image of lymphatic vessels visualized in real time on the monitor screen of the dynamic imaging system. (C) Drawing the lymphatic drainage pathways guided by ICG fluorescence.
Figure 2. Represented images of marked lymphatic…
Figure 2. Represented images of marked lymphatic drainage pathways guided by ICG fluorescence
Red arrows were the lymphatic channels.
Figure 3. Identification the trSLNs with various…
Figure 3. Identification the trSLNs with various input lymphatic ducts
(A) trSLN with one input lymphatic duct. (B) trSLN with one input lymphatic duct. (C) trSLN with three input lymphatic ducts. (D) trSLN with multiple input lymphatic ducts. (E) SLNs with two parallel input lymphatic ducts. (F) trSLNs with bifurcated input lymphatic vessels. Blue arrows were SLNs.
Figure 4. Identification the trSLNs with poSLNs
Figure 4. Identification the trSLNs with poSLNs
(A) Dissection the whole lymphatic vessels and trSLN with three poSLNs. (B) The shiny fluorescent images of A on the monitor screen of the dynamic imaging system. (C) Dissection the whole lymphatic vessels and trSLN with one poSLN. (D) The shiny fluorescent images of C on the monitor screen of the dynamic imaging system. Blue arrows were trSLNs and green arrows were poSLNs.
Figure 5. Identification the trSLNs with paSLNs
Figure 5. Identification the trSLNs with paSLNs
(A) Dissection the whole lymphatic vessels and trSLNs. (B) The shiny fluorescent images of A on the monitor screen of the dynamic imaging system. (C) All the resected trSLNs and paSLNs. (D) The shiny fluorescence images of all trSLNs and paSLNs. Blue arrows were trSLNs and yellow arrows were paSLNs.

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