Imaging methods for the local lymphatic system of the axilla in early breast cancer in patients qualified for sentinel lymph node biopsy

Abstract

Breast cancer is the most common malignancy in women in well-developed countries. Despite a constant increase in its incidence, the percentage of patients diagnosed with the disease in the non-invasive stage is also rising. This allows more frequently for the use of breast-preserving surgical techniques, involving the breast and the regional lymphatic system.According to current guidelines of expert panels and research societies, the recommended method of identifying the sentinel lymph node is the use of an isotope marker with a dye (a combined isotope and dye method). Cooperation with a nuclear medicine unit is essential (performing a preoperative lymphoscintigraphic scan to identify the lymphatic drainage basin and sentinel lymph node). In the case of smaller centers treating breast cancer, it can be associated with a number of difficulties, including organizational ones, and also increasing general treatment costs.A possible solution to these problems is to use alternative techniques of visualizing the sentinel lymph node, which do not require a radiotracer. In this paper we discuss the currently available methods of mapping the lymphatic system of the axillary region in patients with early breast cancer. The review is limited to reporting on methods of proven (based on clinical research) high diagnostic value.

Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis

“…In majority of patients reviewed by us, only the isotope method was used to identify SLN. This approach stemmed out from our previous experience, according to which additional use of a dye did not increase a percentage of successful SLNB …”

Retrospective observational study about reducing the false negative rate of the sentinel lymph node biopsy

“…In recent decades, a majority of studies have been devoted for developing novel, consistent SLN tracing methods, to reduce the FNR of SLNB, [ 12 ] resulting in the currently used methods of tracing SLNs: blue dye, [ 13 ] radioisotope, the combination of blue dye and isotope, [ 14 ] fluorescent dye, [ 15 , 16 ] and nanoparticles. [ 17 , 18 ] Though the novel methods of lymphoscintigraphy confer their own unique advantages in reducing the FNR of SLNB in preclinical studies, their application in practice depends upon further prospective clinical studies to identify suitable protocols, and the uptake of such advanced methods might require some time.…”

“…Since the 1990 s, with the evolution of the lymph node tracing method, and administration and injection routes, the FNR of SLNB has been reduced to a great extent. [ 11 , 12 ] However, each patient's condition is different, and some subjectivity from the surgeons also affects the accuracy of SLNB. For example, some surgeons are inclined to find sentinel lymph nodes (SLNs) in familiar areas but overlook what they might consider “unimportant” anatomical positions.…”

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

“…In order to apply this group of diagnostic techniques, it is necessary to use fluorophores (chemical compounds which fluorescence properties induced by light excitation, i.e. by infrared light) and the appropriate equipment [35][36][37][38], comprising a source of light with a specific wavelengthlight-emitting diode (LED), a charge-coupled device (CCD), which works as a detector of the generated radiation as well as a monitor which makes it possible to track the image during the procedure. Apart from the known clinical applications (mapping the lymphatic system in oncological surgery, plastic and reconstructive surgery, cardiac surgery and transplantology) [38], this method has proven to be useful for evaluation of the surgical margins of tumour resection during BCT [35,36].…”