The Application Of Carbon Nanoparticles Localization In Breast-conserving Therapy Following Neoadjuvant Chemotherapy

ObjectiveThe carbon nanoparticles were injected into breast gland surrounding the tumor,that was under the guidance of ultrasound before neoadjuvant chemotherapy.To synthetically evaluate the tracing effect of sentinel lymph node in sentinel lymph node biopsy,as well as the marking effect of primary tumor in breast-conserving surgery.Materials and MethodsThe prospective study included 32 felmales' clinical data,dignosed as invasive breast carcinoma,from July 1,2015 to July 1,2016.(The study was registered on the website of www.chictr.org.cn,as well as getting funding support from science and technology office of FuJian province(2014Y0035).Their clinical stages ranged from ?A to ?A.The longest diameter of tumor was 3.2±1.4(0.8~6.0)cm.The smallest distance from the tumor to the nipple was 3.5±0.8(2.0~4.9)cm.A suspension of carbon nanoparticles were injected under the guidance of ultrasound before neoadjuvant chemotherapy.The injection sites were 0.5 cm from the apparent margin of the primary lesion.It was injected along 6 tracks far away from the tumor infiltration,and into the deep gland and superficial gland in each track for a toal of 12 times marking.The sentinel lymph node biopsy was accomplished at the same time.The clinical response of breast cancer was going to be evaluated after finish of 4 to 6 cycles neoadjuvant chemotherapy.There were altogether 28 patients meeting the indications of breast-conserving therapy.The lesion was removed along the 0.5cm outer edge of the nanoparticle-stain tissue.The adjustment of operation method was according to the result of frozen section.All sentinel lymph nodes,level I and level II lymph nodes were removed.All of the lymph nodes were examined by pathologist.ResultsThe sentinel lymph node biopsy was accomplished in 32 cases,the sentinel lymph node was detected in 29 cases with dectection rate of 90.6%.The number of black stained sentinel lymph node ranged from 0 to 4,wih an average of 1.8 and precision rate of 93.1%.32 patients completed the neoadjuvant chemotherapy,including CR cases of 9,PR cases of 21,SD cases of 2 and PD cases of 0.28 patients meeting the indications of breast-conserving therapy received the operations.The clinical response included CR cases of 8,PR cases of 18,SD cases of 2 and PD cases of 0.There were 22 cases whose initial incisal margin was negative.There were 5cases who needed secondary resection.One case changed to adapt the modified radicalmastectomy because of positive incisal margin of secondary resection.The diameter of excised mass was 2.7±0.5(1.8~3.5)cm,excluding one case who changed to adapt the modified radicalmastectomy.The smallest distance from the incisal margin to the tumor infiltration was 1.3±0.3(1.0~2.1)cm,excluding 5 case whose response was pCR according to the postoperative pathology.The aesthetic appearance grading was good and above in 24 patients.No recurrence or metastasis was noticed after the surgery(6 to 12 month follow-up;median:9.1months).ConclusionFor the invasive breast carcinoma whose clinical stages range from ?A to ?A,the application of carbon nanoparticles localization is feasible and safe in breast-conserving therapy following neoadjuvant chemotherapy.Its' advantage lies in complete resection of the primary tumor,improving the negative rate of incisal margin,reducing the operation difficulty,retaining the maximum normal breast tissue,reducing the impact on postoperative breast appearance.As the sentinel node tracer,carbon nanoparticles can improve the dectection rate and precision rate of sentinel lymph node biopsy.