REVIEW  SURGICAL TREATMENT OF BREAST CANCER 

Minerva Surgery 2021 December;76(6):550-63

DOI: 10.23736/S2724-5691.21.09002-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Techniques for sentinel node biopsy in breast cancer

Sonia BOVE ¹, Simona M. FRAGOMENI ², Alessia ROMITO ¹ ✉, Danilo DI GIORGIO ³, Pierluigi RINALDI ^{4, 5}, Domenico PAGLIARA ¹, Debora VERRI ¹, Ilaria ROMITO ¹, Ida PARIS ², Luca TAGLIAFERRI ⁶, Fabio MARAZZI ⁷, Giuseppe VISCONTI ⁸, Gianluca FRANCESCHINI ⁹, Riccardo MASETTI ⁹, Giorgia GARGANESE ^{1, 10}

1Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Sassari, Italy; 2Unit of Gynecologic Oncology, Department of Health Sciences of Women, Children and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ³ Unit of General Surgery, Mater Olbia Hospital, Olbia, Sassari, Italy; ⁴ Unit of Radiology and Interventional Radiology, Mater Olbia Hospital, Olbia, Sassari, Italy; ⁵ Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁶ Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁷ Unit of Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁸ Unit of Plastic Surgery, Department of Health Sciences of Women, Children and Public Health, Sacred Heart Catholic University, Rome, Italy; ⁹ Department of Health Sciences of Women, Children and Public Health, Multidisciplinary Breast Center, Sacred Heart Catholic University, Rome, Italy; ¹⁰ Department of Life Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy

Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically nonsuspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction. The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon’s confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time. The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD. This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.

KEY WORDS: Sentinel lymph node biopsy; Breast neoplasms; Radioactive tracers; Indocyanine green