Sentinel lymph node biopsy (SLNB) in breast cancer patients who received neoadjuvant chemotherapy(NAC) has a problem of lower identification and higher false negative rates. To improve this, we compared the sentinel lymph node (SLN) identification rate between the dual method (DM) of indocyanine green fluorescence (ICG-F) plus a radioisotope (RI) and RI alone. In this study, we aimed to compare the prognosis according to the SLN mapping method through the lymphedema(LE) Quality of Life(QoL) in the same patient group.
We analyzed 62 patients who completed LE examinations and a questionnaire. We defined LE as a volume difference between limbs of 200ml or more or a difference within a limb of 200mL or more. The limb volume was measured before and after surgery using volumetry. In addition, the ratio of extracellular water (ECW) to total body water (TBW) and single frequency bioelectrical impedance (SFBIA) at 1kHz and 5kHz was measured using bioelectrical impedance analysis (BIA) for early detection of LE. We regarded ECW/TBW more than 0.39 as overhydrated and used the SFBIA ratio calculated as the ratio of the unaffected arm to the affected arm. QoL was assessed by the EORTC QLQ-BR23.
Among the total of 62 patients, 26 were in the DM group and 36 were in the RI group. LE occurred in 11(42.3%) patients in the DM group and 12(33.3%) patients in the RI group, and there was no statistically significant difference(p=0.470). The number of patients with ECW/TBW greater than 0.39 was respectively 1(3.9%) and 4(11.1%) (p=0.388). The SFBIA ratio measured at 1kHz was 1.01 (0.99-1.03, p=0.994) in both groups, and the same value was shown at 5kHz (p=0.926). As a result of EORTC QLQ-BR23, there was no significant difference in breast and arm symptoms (breast symptoms 16.67 vs. 16.67 p=0.960, arm symptoms 33.33 vs. 33.33 p=0.724).
This study is a prospective study comparing the prognosis before and after surgery according to the SLN mapping method. Compared with RI, DM showed no significant difference in the number of retrieved LNs, LE, and related symptoms. We suggest DM is a useful method that provides visual guidance and is sufficient to replace the RI alone method.
NCC2020-0233.
National Cancer Center.
Has not received any funding.
All authors have declared no conflicts of interest.