Radiotracer technique optimization for breast cancer internal mammary sentinel lymph node biopsy

doi:10.19401/j.cnki.1007-3639.2023.02.006

Abstract

Abstract:

Background and purpose: The modified injection technique developed in Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences has significantly improved the visualization rate of internal mammary sentinel lymph nodes (IMSLN), however there is still a gap between the visualization rate of IMSLN obtained by this technique and that of axillary sentinel lymph nodes (ASLN). The study aimed to further improve the IMSLN visualization rate and promote the widespread use of internal mammary sentinel lymph node biopsy (IM-SLNB) by optimizing the modified injection technique. Methods: A total of 159 patients with primary breast cancer were enrolled in a prospective group and divided into the optimized radiotracer technique group (group A, n=81) and the modified injection technique group (group B, n=78). In group A, ^99mTc-sulfur colloid was injected averagely into parenchyma in the gland's three most abundant regions under ultrasound guidance (total radioactive intensity 1.0-1.3 mCi; 0.8-1.0 mL/point). In group B, 99mTc-sulfur colloid was injected averagely into the parenchyma of the breast at 6 and 12 points under ultrasound guidance (total radioactive intensity 1.0-1.3 mCi; 0.8-1.0 mL/point). Single photon emission computed tomography (SPECT)/computed tomography (CT) lymphoscintigraphy was performed preoperatively, and the sentinel lymph nodes were detected intraoperatively by γ probe. In this study, we evaluated the differences in IMSLN and ASLN visualization rates between the groups, and also analyzed the factors that may affect the IMSLN visualization rate. Results: There was no statistically significant difference in visualization rate of IM-SLN measured by preoperative SPECT/CT between the two groups (P=0.806). The intraoperative visualization rate of IM-SLN was significantly higher in group A than in group B (87.65% vs 70.51%, P=0.008). Analysis of subgroups showed that the intraoperative visualization rate of IMSLN was 92.31% and 83.33% (P=0.315) in group A patients aged ≤50 years and >50 years, respectively, and the intraoperative visualization rate of IMSLN was significantly higher in group B patients aged ≤50 years than in patients aged >50 years (81.58% vs 60.00%, P=0.037). The median in vitro radioactivity count of IMSLN was significantly higher in group A than in group B (160.50 vs 59.00, P=0.005). Conclusion: The optimized radiotracer technique can effectively increase the lymphatic drainage and uptake in the internal mammary region of the radiotracer, which can significantly improve the visualization rate of IM-SLN without affecting the visualization rate of ASLN, and is conducive to the promotion and application of IM-SLNB.

Key words: Breast cancer, Internal mammary sentinel lymph node, Sentinel lymph node biopsy, Modified radiotracer technique

CLC Number:

R737.9

DUAN Baowei, ZHAO Na, BI Zhao, QIU Pengfei, XU Xinghe, CHEN Yuguang, FAN Qingda, WANG Yongsheng. Radiotracer technique optimization for breast cancer internal mammary sentinel lymph node biopsy[J]. China Oncology, 2023, 33(2): 134-141.

Figures/Tables 5

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References 19

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Characteristic	Group A (n=81)	Group B (n=78)	P value	Characteristic	Group A (n=81)	Group B (n=78)	P value
Median age (range)/year	51 (31-68)	51 (23-69)	0.762	Tumor type			0.491
Age range				HR⁺	55	50
≤50 years	39	38		HER2⁺	17	22
>50 years	42	40		TNBC	9	6
Menopausal status			0.669	Tumor location			0.753
Pre	44	45		UOQ	35	34
Post	37	33		LOQ	13	9
T stage			0.448	UIQ	21	18
T₁	40	43		LIQ	2	4
T₂	39	31		Central	10	13
T₃	2	4		Surgery			0.255
Pathological type			0.979	Mastectomy	69	61
CIS	9	10		Breast preserving surgery	12	17
IDC	66	64		Time intervals between injection and SLNB			0.586
ILC	2	1		≤12 h	37	39
Others	4	3		>12 h	44	39

Characteristic	Group A (n=81)	Group B (n=78)	P value
Location of SLN
Axilla only	36	39
Axilla+IMN	40	37
IMN only	0	0
No location	5	2
Total axilla	76	76	0.443
Total IMN	40	37	0.806

Characteristic	Group A (n=81)	Group B (n=78)	P value
Location of SLN
Axilla only	10	23
Axilla+IMN	69	55
IMN only	2	0
No location	0	0
Total axilla	79	78	0.497
Total IMN	71	55	0.008