Comparative Observation Of Common Tracers In Sentinel Lymph Node Biopsy Of Breast Cancer And A Study On Simplifying Its Surgical Procedure

Objective1.To study the detection effect and safety of carbon nanoparticles(CNP),CNP combined with methylene blue(MB),indocyanine green(ICG)combined with MB as tracers in sentinel lymph node biopsy(SLNB)of breast cancer.2.To study the influence of simplified operation in SLNB of breast cancer on operation duration,lymph node detection rate and postoperative complications.Method1.Research on the application of common tracers in SLNB of breast cancer123 patients with primary breast cancer who underwent SLNB in our hospital from January 2017 to December 2022 were selected and divided into CNP group,CNP joint MB group,ICG joint MB group according to the tracer applied.The tracer effect of each group was evaluated according to the detection rate of SLN,the number of SLN detected,false negative,the color development of lymph vessel during the operation,and the adverse reactions related to the tracer after the operation.2.Study on simplifying the procedure of SLNB for breast cancer123 patients with primary breast cancer who underwent SLNB in our hospital from January 2017 to December 2022 were selected and divided into non-tracking group and tracking group according to the operation process of SLNB.In the non-tracking group,the stained lymph nodes were directly examined when the tissue was separated,while in the tracking group,the stained lymph vessel were watched when the tissue was separated,and looked for stained lymph nodes along the lymph vessel.The number of SLN detected,the number of SLN positive,the number of false negative,the operation duration,and the postoperative adverse reactions related to the operation were compared between the two groups to evaluate the Surgical effect.Result We first conducted statistics on the age,menopause status(yes or no),tumor location,tumor location quadrant,and other general data of the three observation groups,and the results exhibited no statistical difference(P >0.05).The pathological data of tumor size,ER(estrogen receptor),PR(progesterone receptor),HER2(human epidermal growth factor receptor 2),Ki67,and molecular typing results of the three observation groups were statistically analyzed.The results demonstrated no statistical difference(P >0.05).The SLN identification rates in the CNP,CNP+MB,and ICG+MB groups were 37/38(97.4%),40/41(97.6%),and 42/44(95.5%),respectively(P > 0.05).The average number of SLNs in the three groups detected was4.92 ± 2.06,5.12 ± 2.18,and 4.57 ± 1.90,respectively(P > 0.05).One case was proved to be false negative through paraffin pathology after operation in each group(P > 0.05).The ideal color rendering rates of lymphatic vessels in the CNP,CNP+MB,and ICG+MB groups were 86.8%,87.8%,and 93.2%,respectively,with no significant difference(P > 0.05).No serious adverse events were found in each group.All 123 patients were divided into two groups according to different SLNB operation methods they underwent: 53 patients in the non-tracking group and 70 patients in the tracking group.General data of the two groups including age,menopause status(yes or no),tumor location,tumor location quadrant,and axillary dissection were statistically analyzed.The results exhibited no statistical significance(P > 0.05).The pathological data including tumor size,ER,PR,HER2,Ki67,and molecular typing results of the two groups were statistically analyzed.The results exhibited no statistically significant difference(P > 0.05).No difference was observed in the application of tracer between the two groups with different SLNB operation methods.CNP was selected in 17 and 21 cases in the non-tracking and tracking groups.CNP+MB was selected in 13 and 28 cases and ICG+MB was selected in 23 and 21 cases,respectively(P > 0.05).The SLN identification rates in the non-tracking and tracking groups were 51/53(96.2%)and 68/70(97.1%),respectively(P > 0.05).The average number of SLNs detected in the two groups was 4.81 ± 2.12 and 4.90 ± 1.99,respectively(P > 0.05).The lymphatic metastasis rates in the two groups were 24.5% and 18.6%,respectively(P > 0.05).The number of false negatives in the two groups was 2 and 1,respectively.The average operation duration for the non-tracking and tracking groups was 16.47 ± 5.78 min and 27.53 ± 7.75 min,respectively.The average operation duration of the non-tracking group was 11.06 minutes shorter than that of the tracking group(P<0.01).The follow-up period was 1 month following operation.Of the 123 patients in the two groups,118 patients were followed up,including 51 patients in the non-tracking group and 67 patients in the tracking group.Only one patient developed upper limb edema in the non-tracking group and 2patients developed upper limb edema in the tracking group.Both groups had no sensory abnormalities and dyskinesia on the affected side(P > 0.05).Conclusion1.This study is the first time to compare the application effect of CNP,CNP joint MB and ICG joint MB tracers in SLNB of breast cancer.It is found that there is no significant difference between them in SLN detection and lymphatic vessel display.2.Neglecting lymphatic vessels and directly looking for stained lymph nodes in SLNB operation has the same effect as standard operation in SLN detection.It has no effect on the results of intraoperative frozen pathology and postoperative paraffin pathology,but it can simplify the operation process,save anesthesia and operation time,reduce the difficulty of operation,and theoretically reduce postoperative complications.