Relationship Between Different Tracers And Sentinel Lymph Node Positive Rate In Breast Cancer

Objective: Indocyanine green(ICG)and methylene blue were used as tracers of sentinel lymph node(SLN)in breast cancer.The positive rates of sentinel lymph node were compared under the simultaneous display of two tracers,single tracer and no tracer.To find out the better method of sentinel lymph node biopsy(SLNB),Which has guiding significance for SLNB of breast cancer.Methods :Selecting 140 patients from July 2017 to December 2018 in Affiliated Hospital of Guilin University Who were confirmed to have breast cancer by preoperative hollow needle puncture or mass resection biopsy.Intraoperative SLNB was performed with ICG and methylene blue combined tracer method.SLNs detected in patients were divided into four classes: Class a: SLNs which were blue stained and fluorescence imaged;Class b: only blue-stained SLN;Class c: SLN with only fluoroscopy;Class d: SLN with neither blue dye nor fluorescence development.The detected SLN was then sent to pathological examination for grouping record.These SLNs were further divided into four groups: The first group: combined group,namely SLN with methylene blue color and/or ICG fluorescence(a + b + c class),The second group: methylene blue group,namely SLN with methylene blue color(a + b class),The third group: ICG group,namely SLN with fluorescent;no shown group(a + c class),The forth group: no display group,namely SLN with neither methylene blue nor ICG fluorescene(d class).The average number of SLN detected and positive rate of metastasis among combined group,methylene blue group,ICG group and no display group were analyzed and compared.Results:A total of 526 SLNs were detected,414 SLNs were detected in the combined group,with an average of 2.83 ± 1.05 and 33 SLNs are metastatic.In methylene blue group,286 SLN were detected,with an average of 1.82 ± 0.96 and 28 SLNs are metastatic.In ICG group,353 SLN were detected,with an average of 2.34 ± 1.01 and 32 SLNs are metastatic.In no display group,112 SLN were detected,with an average of 0.66 ± 0.23 and 2 SLNs are metastatic.The average number of SLN detected in the combined group was higher than that in the methylene blue group,ICG group and no display group(P < 0.05),The average number of SLN detected in ICG group was higher than that in methylene blue group(P < 0.05).The positive rate of SLN in the combined group was higher than that in the methylene blue group(6.27% vs 5.32%),without statistical significance(P = 0.063).The positive rate of SLN in the combined group was higher than that in the ICG group(6.27% vs 6.08%),without statistical significance(P = 0.067 > 0.05).The positive rate of SLN in ICG group(6.08%)was higher than that in methylene blue group(5.32%),without statistical significance(P = 1.000 > 0.05).The positive rate of SLN in combined group(6.27%)was higher than that in no display group(0.38%),with statistical significance(P = 0.000 < 0.05).Conclusions: The application of methylene blue combined with ICG in sentinel lymph node biopsy of breast cancer can improve the number of sentinel lymph nodes detected,the detection probability of metastatic sentinel lymph nodes and the accuracy of evaluating axillary lymph node status,which proves that this method has considerable advantages and can be generalized.