Clinical Application of Multimodal Sentinel Lymph Node-Mapping Method for Patients with Breast Cancer Undergoing...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Neoadjuvant chemotherapy (NAC) improves outcomes for breast cancer, particularly HER2-positive and triple-negative subtypes.
• Sentinel lymph node (SLN) mapping post-NAC faces challenges with lower identification and higher false-negative rates compared to early-stage disease.
• Accurate SLN assessment is crucial for treatment stratification and prognosis after NAC.

Purpose of the Study:

• To evaluate the efficacy of a multimodal SLN-mapping approach following neoadjuvant chemotherapy in breast cancer patients.
• To compare the SLN identification rates and operation times of different multimodal mapping techniques.
• To determine the optimal combination of techniques for post-NAC SLN detection.

Main Methods:

• A prospective, single-center, randomized controlled trial involving 270 breast cancer patients undergoing NAC.
• Patients were randomized into three arms: Arm A (radioisotope [RI] + indocyanine green fluorescence [ICG-F]), Arm B (RI + vital dye), and Arm C (ICG-F + vital dye).
• Primary outcome was the SLN-identification rate; secondary outcome was SLN-operation time.

Main Results:

• Arm A (RI + ICG-F) demonstrated a high SLN-identification rate of 95%, significantly higher than Arm C (79%).
• Comparing Arms A and B, final analysis showed comparable SLN-identification rates (92.6% vs. 90.6%) but a significantly shorter mean detection time in Arm B (7 min vs. 8 min).
• Intra-arm analysis revealed significant differences in detection rates based on the method used, particularly lower rates for vital dye alone in Arm B (72.9%).

Conclusions:

• Multimodal SLN-mapping achieves high post-NAC identification rates in breast cancer.
• While intra-arm identification rates were similar across combinations, specific methods within arms showed varied performance.
• The combination of radioisotope and indocyanine green fluorescence (RI + ICG-F) is an effective dual-method approach for SLN mapping after NAC.