<p>Accuracy of Sentinel Lymph Node Biopsy in Breast Cancer: Pitfalls in the Application of Single Tracers</p>

Abstract

Background: Radioisotopes and blue dyes are used as dual tracers in the current gold standard procedure of sentinel lymph node (SLN) biopsy (SLNB) performed for breast cancer. However, the blue dye or the radioisotope as a single tracer is also being applied in some institutes. We aimed to explore the risk factors for the miss-detection of SLNs with the radioisotope and the blue dye and to describe the distribution of SLNs missed by each tracer. Patients and Methods: Patients undergoing SLNB with radioisotope and blue dye as dual mapping agents were enrolled between August 2010 and August 2018. Radioactivity count, blue dye staining status, and size and location of each SLN were prospectively documented. Results: In total, 2382 SLNs from 1010 patients were included for statistical analyses. The sentinel node identification rate was 100% for dual tracers, 99.4% for radioisotope, and 89.1% for blue dye. SLN identification using the blue dye was more likely to fail in patients undergoing breast-conserving surgery (p < 0.001) and mastectomy with reconstruction (p = 0.005). Furthermore, miss-detection was significantly more frequent in smaller and uninvolved nodes. Among all SLNs, 8.2% were located in level II and one was in level III. Notably, single tracer of blue dye tended to fail in the detection of lymph nodes in higher levels (p < 0.001). Conclusion: This study explored the association between features and the incidence of the failure to detect SLNs using radioisotope and blue dye. The locations of the miss-detected SLNs are demonstrated to provide a reference for SLNBs conducted using blue dye or radioisotope as a single tracer.

Targeting lymph nodes for enhanced cancer vaccination: From nanotechnology to tissue engineering

“…, Technetium-99 m) and indocyanine green. Combined utilization of blue dye and radioactive colloid is regarded as a golden standard for sentinel LN identification in breast cancer [ 40 ]. Nanomaterial-based laboratory advancements are constantly reported, including the colored NPs [ 41 ], fluorescence imaging agents [ 41 ], and even MRI-CT-PET-fluorescence multimodal agents [ 42 ].…”

New classifications of axillary lymph nodes and their anatomical-clinical correlations in breast surgery

“…Of the other studies that cited this classification, none took advantage of the same demarcation and was able to support its truthfulness. Some authors, although interested in Clough et al’s indications, said that surgical treatment of the axillary region should be personalized based on the involvement of the lymph node status and did not report any data regarding the lymph node area involved [ 14 , 15 ].…”

“…After the publication of the results of the ACOSOG Z001120 study and the diffusion of the American Society of Clinical Oncology clinical practice guidelines [ 31 , 32 ] documenting the low usefulness of ALND even in the presence of metastases in the SLN, the traditional concept of axillary dissection in breast cancer has become an issue to be questioned. However, while the role of axillary ultrasound in the preoperative staging and in the follow-up after SLN biopsy procedure and the possibility of avoiding it are currently being evaluated in a prospective study, SLN biopsy remains the gold standard for the axillary management for early-stage breast cancers [ 15 ].…”

“…Although nowadays postoperative upper limb lymphedema occurs in a minority of breast cancer patients, and in particular cases such as inflammatory breast cancer [ 34 ], its development markedly reduces the quality of life. Upper limb lymphedema may be caused by the resection of the lymph nodes and lymphatic vessels during ALND and also during up to 7% of SLN biopsy procedure [ 15 ], in particular when a greater number of non-SLNs are removed to reduce the false-negative rates during this procedure. In this light, the greater the number of resected non-SLNs, the greater the probability of occurrence of upper limb edema [ 3 ].…”

Sentinel Lymph Node Biopsy Mapped With Carbon Nanoparticle Suspensions in Patients With Breast Cancer: A Systematic Review and Meta-Analysis

“…The RI method requires specialized equipment, authorized radiation protection areas, and nuclear medicine licensing, thus limiting the widespread use of this approach. BD, on the other hand, is a cost-effective method for SLNB but possesses a lower detection rate ( 7 ).…”