New concept in selecting blue dye injection site effect on clinical outcome of early-stage breast cancer patients: a retrospective cohort.
Humans
Female
Breast Neoplasms
/ pathology
Retrospective Studies
Middle Aged
Neoplasm Recurrence, Local
/ pathology
Coloring Agents
/ administration & dosage
Neoplasm Staging
Mastectomy
/ methods
Follow-Up Studies
Prognosis
Sentinel Lymph Node Biopsy
/ methods
Rosaniline Dyes
/ administration & dosage
Adult
Aged
Mastectomy, Segmental
/ methods
Injections
/ methods
Alternating site of blue dye injection as per surgical procedure is recommended, to ensure a better visualization of the surgical field
Customizing the injection site of blue dye according to the type of surgery is effective for SLN localization.
New concept of injecting the intraparenchymal blue dye at a quadrant other than of the index lesion should provide concordant outcome as conventional periareolar site
Novel blue dye injection concept providing probable benefit in decreasing re-operation rate
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
03 Aug 2024
03 Aug 2024
Historique:
received:
01
05
2024
accepted:
26
07
2024
medline:
3
8
2024
pubmed:
3
8
2024
entrez:
2
8
2024
Statut:
epublish
Résumé
Clinico-anatomical review and pilot studies demonstrated that intraparenchymal injection at any site, even those not containing the index lesion, or periareolar injections should provide concordant outcomes to peritumoral injections. This was a single-center retrospective cohort at King Chulalongkorn Memorial Hospital. The electronic medical records of patients were characterized into conventional and new injection concept groups. The inclusion criteria were patients who had either a mastectomy or BCS along with SLNB. We excluded patients who underwent ALND, received neoadjuvant therapy, or had non-invasive breast cancer. The primary outcome was the 5-year rate of breast cancer regional recurrence. Additionally, we reported on the re-operation rate, disease-free period, distant disease-free period, mortality rate, and recurrence rates both locoregional and systemic. Recurrences were identified through clinical assessments and imaging. 3 ml of 1%isosulfan blue dye was injected, with the injection site varying according to the specific concept being applied. In cases of SSM and NSM following the new concept, the blue dye was injected at non-periareolar and non-peritumoral sites. After the injection, a 10-minute interval was observed without massaging the injection site. Following this interval, an incision was made to access the SLNs, which were subsequently identified, excised, and sent for either frozen section analysis or permanent section examination. There were no significant differences in DFS, DDFS or BCSS between the two groups (p = 0.832, 0.712, 0.157). Although the re-operation rate in the NI group was approximately half that of the CI group, this difference was not statistically significant (p = 0.355). Our study suggests that tailoring isosulfan blue dye injection site based on operation type rather than tumor location is safe and effective approach for SLN localization in early-stage breast cancer. However, this study has limitations, including being a single-center study with low recurrence and death cases. Future studies should aim to increase the sample size and follow-up period.
Sections du résumé
BACKGROUND
BACKGROUND
Clinico-anatomical review and pilot studies demonstrated that intraparenchymal injection at any site, even those not containing the index lesion, or periareolar injections should provide concordant outcomes to peritumoral injections.
METHOD
METHODS
This was a single-center retrospective cohort at King Chulalongkorn Memorial Hospital. The electronic medical records of patients were characterized into conventional and new injection concept groups. The inclusion criteria were patients who had either a mastectomy or BCS along with SLNB. We excluded patients who underwent ALND, received neoadjuvant therapy, or had non-invasive breast cancer. The primary outcome was the 5-year rate of breast cancer regional recurrence. Additionally, we reported on the re-operation rate, disease-free period, distant disease-free period, mortality rate, and recurrence rates both locoregional and systemic. Recurrences were identified through clinical assessments and imaging.
SURGICAL TECHNIQUE
METHODS
3 ml of 1%isosulfan blue dye was injected, with the injection site varying according to the specific concept being applied. In cases of SSM and NSM following the new concept, the blue dye was injected at non-periareolar and non-peritumoral sites. After the injection, a 10-minute interval was observed without massaging the injection site. Following this interval, an incision was made to access the SLNs, which were subsequently identified, excised, and sent for either frozen section analysis or permanent section examination.
RESULT
RESULTS
There were no significant differences in DFS, DDFS or BCSS between the two groups (p = 0.832, 0.712, 0.157). Although the re-operation rate in the NI group was approximately half that of the CI group, this difference was not statistically significant (p = 0.355).
CONCLUSION
CONCLUSIONS
Our study suggests that tailoring isosulfan blue dye injection site based on operation type rather than tumor location is safe and effective approach for SLN localization in early-stage breast cancer. However, this study has limitations, including being a single-center study with low recurrence and death cases. Future studies should aim to increase the sample size and follow-up period.
Identifiants
pubmed: 39095792
doi: 10.1186/s12957-024-03493-4
pii: 10.1186/s12957-024-03493-4
doi:
Substances chimiques
Coloring Agents
0
Rosaniline Dyes
0
iso-sulfan blue
39N9K8S2A4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
207Informations de copyright
© 2024. The Author(s).
Références
Center MSKC. About Your Sentinel Lymph Node Biopsy, in Memorial Sloan Kettering Cancer Center. 2023.
Dogan NU, et al. The basics of Sentinel Lymph Node Biopsy: anatomical and pathophysiological considerations and clinical aspects. J Oncol. 2019;2019:p3415630.
doi: 10.1155/2019/3415630
Heerdt AS. Lymphatic mapping and Sentinel Lymph Node Biopsy for breast Cancer. JAMA Oncol. 2018;4(3):431–431.
doi: 10.1001/jamaoncol.2017.4000
pubmed: 29167885
Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol. 2014;15(8):e351–62.
doi: 10.1016/S1470-2045(13)70590-4
pubmed: 24988938
Allweis TM, et al. Current controversies in sentinel lymph node biopsy for breast cancer. Breast. 2003;12(3):163–71.
doi: 10.1016/S0960-9776(03)00024-9
pubmed: 14659322
Galimberti V, et al. Long-term follow-up of 5262 breast cancer patients with negative sentinel node and no axillary dissection confirms low rate of axillary disease. Eur J Surg Oncol. 2014;40(10):1203–8.
doi: 10.1016/j.ejso.2014.07.041
pubmed: 25186914
Caruso G, et al. Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients. Acta Radiol. 2014;55(1):39–44.
doi: 10.1177/0284185113493775
pubmed: 23926236
Engel J, Emeny RT, Hölzel D. Positive lymph nodes do not metastasize. Cancer Metastasis Rev. 2012;31(1–2):235–46.
doi: 10.1007/s10555-011-9343-7
pubmed: 22198520
Ferrucci M, Franceschini G, Douek M. New techniques for sentinel node biopsy in breast cancer. Translational Cancer Res, 2018: p. S405–17.
Krag DN, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.
doi: 10.1016/S1470-2045(10)70207-2
pubmed: 20863759
pmcid: 3041644
Bianchi P, et al. Different sites and modes of Tracer Injection for Mapping the Sentinel Lymph Node in patients with breast Cancer. Tumori J. 2000;86(4):307–8.
doi: 10.1177/030089160008600411
Veronesi U, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg. 2010;251(4):595–600.
doi: 10.1097/SLA.0b013e3181c0e92a
pubmed: 20195151
Reimer T, et al. Is Axillary Sentinel Lymph Node Biopsy required in patients who undergo primary breast surgery? Breast Care (Basel). 2018;13(5):324–30.
doi: 10.1159/000491703
pubmed: 30498416
Kavallaris A, Camara O, Runnebaum IB. Subareolar blue dye only injection sentinel lymph node biopsy could reduce the numbers of standard axillary lymph node dissection in environments without access to nuclear medicine. J Cancer Res Clin Oncol. 2008;134(6):667–72.
doi: 10.1007/s00432-007-0333-7
pubmed: 18026990
Vongsaisuwon M, Pongpirul K, Chatamara K. Clinical outcomes and surgical preferences for breast-conserving surgery and mastectomy: a propensity score-matched analysis. Asian Biomed. 2019;13(3):95–100.
doi: 10.1515/abm-2019-0046
Klimberg VS, et al. Subareolar Versus Peritumoral Injection for Location of the Sentinel Lymph Node. Ann Surg. 1999;229(6):860.
doi: 10.1097/00000658-199906000-00013
pubmed: 10363900
pmcid: 1420833
Malhotra C, et al. Efficacy of Periareolar Versus Peritumoral Injection of TC99-Labelled Sulphur Colloid and Methylene Blue Dye for Detection of Sentinel Lymph Node in patients with early breast Cancer: a comparative study. Indian J Surg Oncol. 2021;12(1):119–23.
doi: 10.1007/s13193-020-01235-y
pubmed: 33814841
Noguchi M, Inokuchi M, Zen Y. Complement of peritumoral and subareolar injection in breast cancer sentinel lymph node biopsy. J Surg Oncol. 2009;100(2):100–5.
doi: 10.1002/jso.21308
pubmed: 19479943
Yap RV, De La FM, Serna. Outcomes of Sentinel Lymph Node Biopsy using Blue Dye Method for early breast Cancer - A single-Institution experience in the Philippines. Breast Cancer (Dove Med Press). 2020;12:37–44.
pubmed: 32210610
Skandalakis JE, Shiffman MA. 2009, Springer Berlin Heidelberg: Berlin, Heidelberg. 3–24.
Suami H, Pan WR, Taylor GI. Historical review of breast lymphatic studies. Clin Anat. 2009;22(5):531–6.
doi: 10.1002/ca.20812
pubmed: 19484798
de Moraes FCAd G, Alves VFC, Priantti JN, Gomes GC, Carnevalli SVB, Madeira T, Vilbert M, Stecca C, Figueroa Magalhães MC, et al. Cyclin-dependent kinase 4/6 inhibitors plus endocrine therapy versus endocrine therapy alone for HR-Positive, HER-2-Negative early breast Cancer: Meta-Analysis of Phase III randomized clinical trials. J Personalized Med. 2024;14(5):464. https://doi.org/10.3390/jpm14050464 .
doi: 10.3390/jpm14050464