Application Of Radionuclide Combined With Methylene Blue Method And Indocyanine Green Combined With Methylene Blue Method In Sentinel Lymph Node Biopsy After Neoadjuvant Therapy For Breast Cancer

Objective:To compare the effects of methylene blue(MB)combined with nuclide(Tc-99)and MB combined with indocyanine green(ICG)in sentinel lymph node biopsy(SLNB)after neoadjuvant chemotherapy(NAC),and to evaluate the two indicators The application value of tracing method in SLNB after NAC for breast cancer,and the feasibility of SLNB after NAC for breast cancer and the safety of ICG combined and MB method instead of Tc-99 combined with MB.Methods:According to the inclusion and exclusion criteria,81 patients who were diagnosed with breast cancer and axillary lymph node positive and received complete neoadjuvant treatment from May 2020 to October 2021 in the breast surgery department of our hospital were enrolled.SLNB was performed under MB+Tc-99 and MB+ICG imaging respectively,using Tc-99+MB method in 38 cases and ICG+MB method in 43 cases.Compare the detection status,false negative rate and sensitivity of the two groups of tracing methods SLNB.Results:In this study,2 patients in the radionuclide combined MB group had tracer leakage during SLNB,so SLNB could not be performed,and ALND was directly performed.In the ICG combined with MB group,there were 3 patients with tracer leakage during dedicated SLNB,so SLNB could not be performed,and ALND was performed directly.The above 5 patients failed to track and were excluded.In ALN clinical turn negative after NAC,patients with>2 SLNs detected,false negative was 5.8%,with a detection rate of 95.7% and an accuracy of 97.8%.False negative results were detected in 25.0% of patients with≤2 SLNs,with a detection rate of 81.8% and an accuracy of 54.5%.Among the patients with>2 ALNs detected by SLNs who did not turn negative clinically after NAC,20.0% were false negative,with a detection rate of 100.0% and an accuracy of54.5%,and 6 patients were≤2 SLNs detected,with a false negative rate of 66.6%,with a detection rate of 85.7% and an accuracy of 42.8%.In the radionuclide+MB group,27 patients have more than 2 SLNs detected,6patients have detected SLNs no more than 2,and 3 patients have no SLN detected.Thus,the detection rate is 91.6%(33/36),the average number of detected SLNs is 5.08±1.97,and the sensitivity is 85.7%(12/14),the false-negative rate is 14.2%(2/14).In the ICG+MB group,29 patients have more than 2 SLNs detected,9 patients have detected no more than 2 SLNs,and 2 patients have no SLN detected.The detection rate is 95.0%(38/40)and the average number of detected SLNs is 4.65±2.68,the sensitivity is 80.0%(12/15),the false negative rate is 20.0%(3/15).In our study,there were no severe allergic reactions in two groups during and after the operation.And 5 and 3 patients developed temporary pigmentation in the ICG+MB and radionuclide+MB groups,respectively.However,all the pigment disappeared after a month and a half of follow-up.Transient pigmented urine associated with the tracer was observed in 27 patients injected with radionuclide combined with MB and 33 patients injected with ICG.Conclusion:This study suggests that the above two tracing methods are both very safe,there is no significant difference in tracing effect between ICG combined with MB and radionuclide combined with MB.In most developing countries,MB+ nuclides cannot be carried out due to technical and economic constraints,so MB+ICG,which is simpler to operate and easier to popularize,can be considered instead.For patients with negative lymph nodes after NAC,when SLN>2,the false negative rate is lower,and SLNB can be considered.Regardless of whether the lymph nodes become negative or not after NAC,the false negative rate is higher when the SLN is less than or equal to 2,and SLNB after NAC needs to be cautious.