Application Of Indocyanine Green Fluorescence Tracing Technology Combined With Methylene Blue Staining In Sentinel Lymph Node Biopsy Of Early Breast Cance

Background: Sentinel lymph node biopsy(SLNB)is a standard method adopted in the world at present,which is the double tracer method of radionuclide combined with blue dye.However,the accessibility of nuclides is poor in China.For various reasons,most hospitals in China use methylene blue(MB)as a tracer for SLNB.However,SLNB stained with MB has some defects,such as low detection rate,few detected particles and high False negative rate(FNR).In recent years,the near-infrared fluorescence tracer technique with Indocyanine green(ICG)as the developer has been applied to SLNB of breast cancer.At present,most studies think that the detection rate and number of SLNB with MB combined with ICG in sentinel lymph node(SLN)are higher than that with simple blue dye method,which is comparable to the current gold standard blue dye plus nuclide.But can the improved detection rate and the number of detected particles reduce the FNR of SLNB? Has it changed our clinical decision on axillary management? There are few related reports,and more clinical data are needed to verify them.Objective: On the one hand,this study verifies that ICG can indeed be used as a qualified tracer for SLNB;On the other hand,it is verified whether the double tracer SLNB method can help reduce the FNR of SLNB stained with single MB in early breast cancer and change the axillary treatment of some patients.Methods: According to the inclusion and exclusion criteria,patients with c T1-2N0M0 breast cancer who have undergone surgical treatment in our hospital since January 2020 were selected.SLNB with double tracers was performed on these patients,and the cut SLN was marked as MB stained and ICG developed SLN(MB(+)ICG(+)SLNs),MB stained but ICG not developed(MB(+)ICG(-)SLNs)and MB unstained but ICG developed(MB(-)SLNs)according to the dyeing situation.According to the staining and metastasis of SLNs during operation,combined with the clinical data of patients,this paper studies whether the double tracer SLNB method can reduce the FNR of SLNB stained with single MB in early breast cancer and change the axillary treatment of some patients.Results: A total of 163 patients were included in this study,among which 150 patients successfully detected SLN by single MB staining,the detection rate was 92%(150/163),and the number of SLN was 345,with an average of(2.13 ± 1.19)per case.There were 40 p SLNs40 in 32 patients,including 38 in MB(+)ICG(+)group and 2 in MB(+)ICG(-)group.160 patients with SLN were successfully detected by double tracer SLNB method,the detection rate was 98.16%(160/163),and 619 SLN were detected,with an average of(3.83±1.79)SLN per case.There were 52 p SLNs in 35 patients,including 38 p SLNs in MB(+)ICG(+)group,2 p SLNs in MB(+)ICG(-)group and 12 p SLNs in MB(-)ICG(+)group.The detection rate and number of p SLNs by double tracer SLNB method were higher than that by single MB staining,and there was statistical difference between the two groups(p <0.05)The ICG development rate of MB blue stained SLN was 93.91%.Compared with MB blue stained FNR,the double tracer SLNB method decreased by 2.04%(3/147),and changed the clinical management decision of axillary in some patients.Conclusion: SLNB with double tracers significantly increased the detection rate of SLN in early breast cancer,and confirmed that ICG can be used as a qualified tracer for SLNB in early breast cancer,helping to locate p SLNs that cannot be stained with single MB.Compared with single MB staining,double tracer method can reduce FNR and change the clinical treatment decision of axillary in some patients.