Abstract:
Introduction: In 2020 more than 2.2 million cases of breast
cancer were registered, and these figures indicate that this
disease is very widespread. Lymphatic metastasis is one of the
most important causes of local recurrence of breast cancer and
is unfavorable factor of prognosis.
The purpose of the work is to improve the algorithm of
intraoperative diagnosis of the sentinel lymph node in patients
with breast cancer.
Material and methods: Between 2009 and 2016, 400 patients
with T1-T3N0M0 breast cancer were operated at the Odesa
Regional Clinical Hospital. Two types of dyes – Patent Blue
and ICG were used. The patients who had mastectomy with
sentinel lymph node biopsy as a rule had a clinical diagnosis of
T2-T3N0M0 breast cancer. In group 1, 100 patients had sentinel
lymph node biopsy. Staining of lymph nodes was performed
using Patent Blue. In group 2, sentinel lymph nodes biopsy was
conducted using Patent Blue and another fluorescent dye ICG,
which was also administered subdermally.
Results: A total five-year survival rate after axillary lymph
dissection and sentinel lymph node biopsy was 91% and 92%,
respectively. A five-year recurrence-free survival rate after
axillary lymph dissection was approximately 82.2%, and after
sentinel lymph node biopsy – 83.9%. Regional recurrence in the
sentinel lymph nodes on the affected side were found in only
1.1% of cases. The sentinel lymph nodes were intact in 58% of
patients, so, the next lymph dissection was not performed. The
affected lymph nodes were observed in 42% of patients.
The time of follow-up ranged from 60 to 180 months. The
recurrence was registered in 0.2%. The study revealed no
difference in total and recurrence-free survival rate between the
groups.
Conclusions: With detected mts lesions of the inguinal
(sentinel) lymph nodes, the operation should be continued
with an obligatory determination of the second and third order
lymph nodes. The extent of surgical intervention is determined
on the operating table based on the results of intraoperative
histological examination. The fluorescent lymphography
method has a high accuracy – 99%, which allows to recommend
it for implementation into clinical practice.
