Precise Sentinel Lymph Node Biopsy In Breast Cancer Guided By Preoperative Ultrasound Combined With Intraoperative Lymphatic Drainage

Background Breast cancer has become the highest incidence of women in the world,and has been paid more and more attention.Lymphatic vessels are the main way of metastasis of breast cancer.The advanced cancer cells are first transferred to the first lymph nodes through their lymphatic vessels.They are called Sentinal lymph node(SLN).The exact SLN status is very important for the management of the armpit,because the false negative results can lead to inaccurate assessment of local lymph nodes and inadequate treatment strategies.In late 1990s,sentinel lymph node biopsy(Sentinal lymph node biopsy,SLNB)technology gradually developed at present,SLNB has become the standard treatment for early breast cancer,which can significantly reduce the axillary lymph node dissection caused limb edema,upper limb abnormal feeling and a series of complications.However,SLNB operation itself is not in the international standard,there were still a lot of controversy,including SLNB indications,select the SLNB tracer and injection site,and the exact number of SLN resection,different excision biopsy can affect the number of false negative rate of SLNB in a certain extent.SLNB false negative may increase the patients ' local recurrence and poor prognosis.Therefore,it is an important problem for clinicians to explore the method of improving the detection rate of sentinel lymph nodes and reducing the false negative rate.Objective Sentinel lymph node biopsy(SLNB)was monitored from pre-operation to operation to achieve accurate treatment of sentinel lymph node biopsy and to determine its clinical application value.Methods Axillary lymph nodes were assessed by ultrasound before operation.We marked the lymph nodes that were near breast and abnormal enlarged.Intraoperatively,using both methylene blue and indocyanine green(ICG)stained on the lymphatic and lymph nodes.The lymphatic drainage images were drawn according to the real-time imaging of the lymphatic vessels,and the lymph nodes and their connected lymph nodes were dissected.So we had distinguished the true sentinel lymph nodes(trSLN),para-SLNs(paSLNs)and post-SLNs(poSLNs),and then only the trSLN was resected for biopsy in order to avoid excessive removal of lymph nodes.Results Through the evaluation of 142 cases of breast cancer patients,comparison of preoperative lymph node color ultrasound evaluation and postoperative histopathology preoperative,ultrasound diagnosis coincidence rate was 75.2%,The sensitivity was 59.7%,the specificity was 93.1%,the negative predictive value was 66.7%,and the positive predictive value was 90.9%;SLNB detection rate,specificity,sensitivity,false negative rate(FNR)were100%,100%,88.5%,11.5%;The average number of detected is 2.9.Lymphatic drainage of primary tumor is more outward direction,and subcutaneous gland excision can affect lymphatic drainage.SLN is stained by ICG and methylene blue and it can also stain the next stop lymph node,poSLN,along the SLN's output lymphatic tube.During operation,only trSLN was removed without excision of the surrounding enlarged lymph nodes,the effect of false negative was not statistically significant.There was significant difference in the false negative of the multifocal tumors(P=0.009),but there was no significant difference in the false negative about the preoperative color Doppler ultrasound assessment of lymph node status,paSLN metastasis and tumor size.Conclusion Combined with preoperative ultrasonography,the sentinel lymph node biopsy guided by intraoperative lymphatic drainage can easily and accurately identify the trSLN rather than the same stained poSLN.It is proved that only the excision of trSLN in the operation but the multiple excision of paSLN can not only guarantee the low trauma of the operation,but also have no statistical significance to the effect of the false negative.For multifocal tumors,the risk of FNR is high,and SLN should be looked for carefully during the operation,and the preoperative core needle biopsy can be considered to avoid the destruction of the lymph drainage by the intraoperative excision biopsy,which leads to the occurrence of false negative.