Breast Cancer Clinical Trial
Official title:
The Comparative Analysis of Multimodal Markers to Identify Sentinel Lymph Node in Breast Cancer
Sentinel lymph node (SLN) biopsy is the gold standard method to stage axilla in breast cancer. The aim of the study is to compare the efficiency of various methods to identify SLN is breast cancer patients.
Various markers has been used for SLN biopsy including isosulfan blue (patent blue),
indocyanine green (ICG), radioisotope colloid (RAIC) and ultrasound (US) with several
advantages and disadvantages. In this study investigators designed an algorithm using the
combination of mapping with patent blue, ICG, RAIC and US to compare the accurate
identification of SLN in breast cancer patients. The protocol is based on the hypothesis that
identification rate of SLN is increased with multiple agents. Patent blue and ICG provides
visual guidance. The combination of dyes with sonographic and RAIC method have the potential
to prevent obstacles and ensure better outcomes as an identification strategy.
Patent blue provides visual identification of the SLN. ICG fluorescence can be detected
percutaneously and by means of fluorescence imaging system in real time. RAI has several
advantages, but disadvantages as well, like cost and invisibility. RAI can only be detected
and confirmed by means of sound and numerical value through gamma probe. All breast cancer
patients underwent axillary ultrasound before SLNB with different mapping combinations. The
determination of abnormal axillary lymph node was followed by ultrasound-guided FNA cytology
of these nodes. The sonographic abnormality criteria of the nodes were defined as; completely
hypoechoic node, asymmetric focal hypoechoic node, cortical lobulation more than 3, cortical
thickness >2mm, totally spheric appearance, absence of fatty hilum and compromise of normal
vascularity (hypervascularization from various poles). Patients with negative results of FNA
would undergo SLNB. Lymphatic mapping was performed with abovementioned dyes and radioactive
colloid. Before the incising for SLNB real time intraoperative US was performed and
suspicious axillary lymph nodes were seen by ultrasound guidance. In the SLNB operation,
radioactive or dyed nodes and sonographically suspicious nodes were removed and labeled
separately for pathological examination.
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