Indocyanine Green And Methylene Blue Dye Guided Sentinel Lymph Node Biopsy In Early Breast Cancer:A Single-Center Retrospective Survival Study In 1574 Patients

Objective:A single-center retrospective study of the long-term effects of indocyanine green(ICG)combined with methylene blue(MB)on sentinel lymph node biopsy(SLNB)in patients with early clinical node-negative(c N0)breast cancer was conducted to explore the efficacy and safety of the combined use of these two tracers.Methods:Between June 2014 and December 2018,clinicopathological and postoperative treatment follow-up data were collected from 1708 patients with early-stage c Tis-2N0M0 breast cancer who underwent SLNB using ICG combined with MB dual-tracer method at the Department of Breast Surgery in the First Hospital of Jilin University.Among them,1574 patients met the inclusion criteria of this study.Statistical indicators included the identification rate of SLNB with ICG combined with MB dual-tracer,the number of sentinel lymph nodes,regional lymph node recurrence,disease-free survival(DFS),overall survival(OS),and arm lymphedema were analyzed.Results:Among the 1574 patients,1569 patients had sentinel lymph nodes successfully detected during surgery,with a detection rate of 99.7%;the median number of sentinel lymph nodes removed was 3;316(20.1%)of these patients had metastases in their sentinel lymph nodes.No tracer-related side effects occurred during hospitalization.43 patients who were lost to follow-up after discharge were excluded and long-term follow-up data were obtained for the remaining patients.A total of 1531 patients were included in the survival analysis,with a median follow-up of 4.7(0.5-7.9)years.Adverse events occurred in 75 patients during the follow-up period,of which 65 were related to breast cancer.310 patients with positive sentinel lymph nodes had a 5-year DFS and OS of90.6% and 94.7%,respectively.The 5-year DFS and OS of the 1221 patients with negative sentinel lymph nodes were 95.6% and 97.3%,respectively.The postoperative regional lymph node recurrence rate was 0.7% in patients with negative sentinel lymph nodes,and the incidence of arm lymphedema after SLNB-only was 2.7%.Conclusion:The ICG combined with MB dual-tracer method is an effective tracer with a high detection rate and identification of more sentinel lymph nodes,which is an effective tracing method.In addition,its side effects are rare and the longterm prognosis is safe.It has certain effectivity and safety,which can be used in SLNB of patients with early c N0 breast cancer.