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Techniques for sentinel node biopsy in breast cancer.

Sonia Bove1, Simona M Fragomeni2, Alessia Romito3

  • 1Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Sassari, Italy.

Minerva Surgery
|August 2, 2021
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Summary

Sentinel node biopsy (SNB) is standard for breast cancer staging. Newer techniques like indocyanine green (ICG) show promise, offering comparable accuracy to traditional methods with potential advantages in detection rates.

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Medical Imaging

Background:

  • Sentinel node biopsy (SNB) is the standard for staging breast cancer (BC) in patients with clinically negative axillary lymph nodes (LNs).
  • SNB minimizes complications associated with axillary lymph node dissection, such as lymphedema.
  • The traditional gold standard SNB technique involves dual labeling with blue dye (BD) and technetium-99m labeled nanocolloid (Tc-99m).

Purpose of the Study:

  • To review common SNB techniques for breast cancer.
  • To focus on recent innovations and alternative tracers for SNB.
  • To evaluate the accuracy and detection rates of various SNB methods.

Main Methods:

  • This paper presents a narrative review of SNB techniques in breast cancer.
  • It discusses established methods and newer tracers like indocyanine green (ICG) and superparamagnetic iron oxides (SPIO).
  • It also considers emerging imaging techniques such as contrast-enhanced ultrasound (CEUS).

Main Results:

  • Newer SNB techniques demonstrate accuracy and detection rates comparable to the standard Tc-99m/BD method.
  • Indocyanine green (ICG) fluorescence technique showed superior detection rates (DR) and the lowest false-negative rate (FNR).
  • The detection rate order was ICG > SPIO > Tc > dual modality (Tc/BD) > CEUS > BD.

Conclusions:

  • The choice of SNB technique depends on surgeon expertise, nuclear medicine availability, and institutional resources.
  • Innovations in tracers and imaging aim to improve SN detection and reduce unnecessary surgeries.
  • While CEUS is under investigation, ICG and SPIO show significant promise for enhanced SNB accuracy in breast cancer staging.