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Minerva Surgery 2021 Aug 02

DOI: 10.23736/S2724-5691.21.09002-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

1 Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy; 2 Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 3 General Surgery Unit, Mater Olbia Hospital, Olbia, Italy; 4 Radiology and Interventional Radiology Unit, Mater Olbia Hospital, Olbia, Italy; 5 Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 6 Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 7 Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 8 Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Chirurgia Plastica, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy; 9 Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy; 10 Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy


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INTRODUCTION: Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically non suspicious 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.
EVIDENCE ACQUISITION: 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.
EVIDENCE SYNTHESIS: 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.
CONCLUSIONS: 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 neoplasm; Radioactive tracers; Indocyanine green

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