Clinical Study Of Sentinel Lymph Node Biopsy With Neoadjuvant Chemotherapy In Breast Cancer

Objective: The purpose of this study was to detect and label sentinel lymph nodetran(SLNs)with indocyanine green indocyanine green(ICG)combined with ultrasound guided biopsy before neoadjuvant chemotherapy.Sentinel lymph node biopsy after neoadjuvant chemotherapyne after neoadjuvant chemotherapy The clinical feasibility of sentinel lymph node biopsy before and after neoadjuvant chemotherapy,the consistency of regional sentinel lymph nodes before and after neoadjuvant chemotherapy and the influencing factors were 3,and the retraction of axillary lymph nodes after neoadjuvant chemotherapy.Methods: From April 2015 to February 2018,130 patients with breast cancer diagnosed in the breast center of Hebei Province were selected and divided into two groups: 90 patients with early breast cancer whose axillary lymph nodes were negative in clinical examination and imaging examination.Another group of 40 patients with locally advanced breast cancer received neoadjuvant chemotherapy.Early breast cancer group: preoperative localization of SLN was performed by ultrasound combined with ICG fluorescence imaging,and 2-4 biopsies were performed on the selected SLN.Implantation of titanium clip markers,ICG blue dye tracer was performed during the operation.The consistency between pre-labeled SLN and SLN during operation,and the coincidence between preoperative sentinel lymph node biopsy and SLN taken during operation;Forty patients with locally advanced neoadjuvant chemotherapy were studied.The sentinel lymph node biopsy was confirmed by ultrasound ICG fluorescence imaging combined with guided sentinel lymph node biopsy before chemotherapy,and the titanium clip was placed after the scheduled neo-adjuvant chemotherapy was completed.The sentinel lymph node biopsy was conducted under the guidance of ICG blue dye,and then ALND was performed to determine the accuracy of SLN labeling,the consistency with pathological diagnosis and other influencing factors of neoadjuvant chemotherapy on sentinel lymph node biopsy.Results:1.Detection Rate of SLN via Ultrasound & ICG Fluorescent-based ImagingBefore the surgery,the detection rate is 100%(90/90);before Neoadjuvant Chemotherapy,the detection rate is 100%(40/40).2.Intraoperative ICG fluorescence imaging combined with blue dye tracing was used to locate the SLN rate in early breast cancer group.During the operation,82 of 90 cases of SLN were detected with ICG blue dye double tracer.The consistency test between the number of SLN detected before operation and the number of SLN taken during operation was 0.669.the correlation was general and the consistency was good.In neo-adjuvant chemotherapy group,40 patients with locally advanced breast cancer were treated with ICG fluorescence imaging combined with methylene blue staining.The consistency was that the area under the 92.5%(37/40)ROC curve was0.500 and 95 CI was 0.241~0.759(P=0.042 < 0.05).3.Comparison of pathological diagnosis between SLN biopsy and intraoperative SLNB;the sensitivity,specificity,false negative rate,correct index and coincidence rate of SLN biopsy in detecting axillary lymph node metastasis were 62.5,100~74 / 74,37.5 / 16,0.6respectively,respectively.Intraoperative SLNB evaluation was performed.The sensitivity of SLN metastasis is 93.815 / 16,the specificity is 1000.74 / 74 / 74,the false negative rate is 6.25 / 16,the correct index is 0.9and the coincidence rate is 98.8989 /90).Kappa consistency test showed that the Kappa value of preoperative SLN hollow needle biopsy was 0.733,and the Kappa value of intraoperative SLNB was 0.846% ROC curve area.Further,the area under ROC curve of preoperative SLN puncture biopsy was 0.813 995 CI 0.663 t 0.962 U P < 0.01,which was consistent with postoperative paraffin pathology.The area underthe ROC curve was 0.969 V 95% confidence interval was 0.691.00(P < 0.01),which was in good agreement with the pathological results of paraffin wax after operation.4.In 38 cases with SLN positive before chemotherapy,the pathological diagnosis showed that the axillary lymph nodes of 6 patients with SLN changed from positive to negative,all of them were negative in axillary lymph nodes after neoadjuvant chemotherapy.5.The displacement of titanium clip after neoadjuvant chemotherapy was analyzed in 40 cases.Among them,37 patients could find the lymph nodes labeled with titanium clip in the sentinel area during the operation by using ICG fluorescence imaging with methylene blue dye double tracer technique.3cases did not find the titanium clip in the sentinel area.37 cases successfully found the titanium clip.Case: 30 cases of titanium in the first sentinel lymph node,Among 7 cases of titanium clip in non-first sentinel lymph node,3 cases did not find titanium clip in the sentinel region: one case had 5 sentinel lymph nodes removed during operation,the other 2 cases had removed 3 and 2sentinel lymph nodes respectively.After all lymph nodes were dissected,two patients were found to have titanium clip markers in non-sentinel lymph nodes by means of radiology(molybdenum target X ray).Titanium clip markers were found in one patient outside the lymph node(i.e.in the gland).6.The removal rate of titanium clip in early breast cancer group and neoadjuvant chemotherapy group was compared.In 90 cases of early breast cancer group,82 cases detected labeled titanium clip in 40 cases of neoadjuvant chemotherapy group.37 cases of neo-adjuvant chemotherapy group were consistent with SLN labeled before chemotherapy.The t value of two samples was 0.364(P =0.717>0.05).There was no significant difference between early breast cancer group and neoadjuvant chemotherapy group.There was no significant difference in the technique of using ultrasound ICG fluorescence imaging to accurately locate SLN with titanium clip label in both early breast cancer group and neoadjuvant chemotherapy group.Conclusions:1.ICG fluorescence imaging combined with ultrasound guidance can accurately identify and locate SLNs.2.ICG fluorescence imaging combined with blue dye can be used to accurately track preoperative localization of SLN.Neoadjuvant chemotherapy has no effect on accurate removal of SLN.3.Compared with intraoperative SLNB,the false negative rate of preoperative SLN biopsy was higher than that of intraoperative SLN.4.After neoadjuvant chemotherapy,non-sentinel lymph nodes were negative in patients with negative sentinel lymph nodes,suggesting that SLNB negative after neoadjuvant chemotherapy in patients with positive axillary lymph nodes could be avoided.5.Titanium clip displacement after neoadjuvant chemotherapy:chemotherapy can cause changes in the structure and morphology of the sentinel lymph nodes,and influence the distribution of lymphatic vessels,resulting in deviation in the first sentinel lymph node excision.6.Titanium clip was removed successfully in early breast cancer group and neoadjuvant chemotherapy group.The method of metal titanium clip labeling to locate the first SLN can be used in early breast cancer and locally advanced breast cancer patients,and it is accurate and reliable.