Biópsia do Gânglio Sentinela Guiada por Fluorescência no Cancro da Mama: Taxa de Deteção e Performance Diagnóstica

Abstract

Introduction: Sentinel lymph node biopsy is currently the standard surgical procedure for lymph node staging in patients with early stage breast cancer. It is performed using different techniques, such as the injection of vital dyes and / or radioisotopes and, more recently, guided by fluorescence using Indocyanine green. The aim of this study is to assess the detection rate of sentinel lymph node using Indocyanine green in breast cancer patients according to factors related to the patient and the tumor.Material and Methods: Retrospective study of a random sample of patients with breast cancer, treated and followed at Centro Hospitalar São João, in Porto, between 2012 and 2016.Results: Indocyanine green detection rate was over 90% and its diagnostic accuracy was similar to other methods described in the presence of metastatic involvement of lymph nodes.Discussion: There was no statistically significant difference between the three methods in the detection rates in subgroups of older women, with normal weight and in those who underwent previous surgery in breast or axilla or neo-adjuvant chemotherapy.Conclusion: Indocyanine green is a potential alternative method to other sentinel lymph node screening techniques, appearing as a future option for breast cancer centers with no nuclear medicine department. However, it is essential to carry out further research in order to define the ideal patients’ profile that maximizes the method’s effectiveness.

An Updated Review on the Emerging Role of Indocyanine Green (ICG) as a Sentinel Lymph Node Tracer in Breast Cancer

“…On the contrary to the above studies, a prospective trial from the UK that enrolled all SLNB eligible breast cancer patients who underwent combined ICG + BD-guided SLNB found that ICG is effective irrespective of the patients BMI [21]. Finally, the retrospective study by Vaz et al on the combined triple use of ICG + RI + BD for SLNB reported that there was no statistically significant difference regarding the performance of either of the three methods in comparison with the patient's BMI [48].…”

“…Several single-group studies examined the effectiveness of ICG as SLNB tracer, by evaluating the clinical data of patients that have undergone SLNB directed by all three tracers, ICG + BD + RI. These studies reported an IRs of 91.4% to 96% for the use of ICG [47][48][49][50]. Furthermore, Somashekhar et al who analyzed the data of 100 clinically node-negative breast cancer patients who received ICG + BD + RI guided SLNB, concluded that the detection rate of ICG was 96%, not significantly different than the IR = 94% for the dual BD + RI method.…”

Radiofármaco: Uso Em Cirurgia De Remoção De Linfonodo Sentinela

“…O LS é definido como o primeiro linfonodo da cadeia linfática que recebe a drenagem do tumor (Silva et al, 2021). A detecção do LS tem a finalidade de prever a condição linfonodal, evitando assim o esvaziamento ganglionar nos pacientes que não tenham comprometimento metastático (Vaz;Peleteiro, 2018). A cirurgia é pequena e menos agressiva, removendo apenas os linfonodos identificados pelo método, já que o esvaziamento linfonodal pode trazer contrariedades importantes como seromas, hematomas, linfedema, sensibilidade local, dor, alterações de movimento relacionada ao membro e internações (Oliveira;Lima;Carvalho, 2018).…”