j health sci med / jhsm Journal of Health Sciences and Medicine 2636-8579 MediHealth Academy Yayıncılık 10.32322/jhsm.1266154 Health Care Administration Sağlık Kurumları Yönetimi Sentinel lypmh node biopsy in early breast cancer: preliminary results of the combined technique of CT lymphography and blue-dye https://orcid.org/0000-0002-4429-6996 Mese Ismaıl SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL ERENKÖY RUH SAĞLIĞI VE SİNİR HASTALIKLARI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ https://orcid.org/0000-0002-4993-4010 Arslan Arzu KOCAELİ ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0000-0003-1616-9436 Güler Sertaç Ata KOCAELİ ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0000-0002-9405-9112 Vural Çiğdem KOCAELİ ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0000-0002-2133-3336 Utkan Nihat Zafer KOCAELİ ÜNİVERSİTESİ, TIP FAKÜLTESİ 05 31 2023 6 3 680 685 03 16 2023 05 23 2023 Copyright © 2018, Journal of Health Sciences and Medicine 2018 Journal of Health Sciences and Medicine

Aim: The aim of this study was to evaluate the efficacy of CT lymphography in sentinel lymph node biopsy for early stage breast cancer and to investigate its contribution to the conventional blue-dye method.Material and Method: A total of 47 patients with early stage breast cancer underwent preoperative CT lymphography for lymph node mapping before sentinel lymph node biopsy with blue-dye method. The lymph nodes identified by CT lymphography and/or blue-dye method were examined for metastatic involvement. The sentinel lymph node detection rates of CT lymphography and blue-dye method were compared using t-tests.Results: The sentinel lymph node detection rate with blue-dye method (87.2%) was significantly higher than with CT lymphography (66.0%) (P=0.027). However, the combined method (blue-dye method and/or CT lymphography) increased the detection rate (95.7%) (P=0.267). Benign sentinel lymph nodes were detected more often with CT lymphography (P=0.366), while metastatic sentinel lymph nodes were detected more often with blue-dye method (P=1,000). Upper outer quadrant tumors were detected less successfully with CT lymphography and more successfully with blue-dye method (P=0.220 and P=0.674, respectively). The success rate of CT lymphography in younger patients (less than 50 years old) was higher compared to older patients (P=0.001).Conclusion: CT lymphography was found to be insufficient as a standalone method for sentinel lymph node biopsy. However, it could be used as a complementary method to blue-dye method to increase the success of sentinel lymph node detection.

 Breast cancer CT lymphography lymph nodes sentinel lymph node sentinel lymph node biopsy Marino MA, Avendano D, Zapata P, Riedl CC, Pinker K. Lymph node imaging in patients with primary breast cancer: Concurrent diagnostic tools. Oncologist 2020; 25: e231-42. De Cataldo C, Bruno F, Palumbo P, et al. Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: A narrative review. Gland Surg 2020; 9: 2225-34. Chayakulkheeree J, Pungrassami D, Prueksadee J. Performance of breast magnetic resonance imaging in axillary nodal staging in newly diagnosed breast cancer patients. Pol J Radiol 2019; 84: e413-8. Lee B, Lim AK, Krell J, et al. The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer. Am J Roentgenol 2013; 200: W314-20. Zhou P, Wei Y, Chen G, Guo L, Yan D, Wang Y. Axillary lymph node metastasis detection by magnetic resonance imaging in patients with breast cancer: a meta-analysis. Thorac Cancer 2018; 9: 265-71. Sasada S, Masumoto N, Kimura Y, et al. Identification of axillary lymph node metastasis in patients with breast cancer using dual-phase FDG PET/CT. AJR Am J Roentgenol 2019; 213: 1129-35. Kutluturk K, Simsek A, Comak A, Gonultas F, Unal B, Kekilli E. Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer. Niger J Clin Pract 2019; 22: 63-8. Assi HI, Alameh IA, Khoury J, et al. Diagnostic performance of FDG-PET/CT scan as compared to US-guided fna in prediction of axillary lymph node involvement in breast cancer patients. Front Oncol 2021; 11: 740336. Stanzel S, Pernthaler B, Schwarz T, Bjelic-Radisic V, Kerschbaumer S, Aigner RM. Diagnostic and prognostic value of additional SPECT/CT in sentinel lymph node mapping in breast cancer patients. Nuklearmedizin 2018; 57: 92-9. Gizewska A, Witkowska-Patena E, Osiecki S, Mazurek A, Stembrowicz-Nowakowska Z, Dziuk M. Utility of single-photon emission tomography/computed tomography for sentinel lymph node localization in breast cancer patients. Nucl Med Commun 2017; 38: 230-8. Motomura K, Izumi T, Tateishi S, et al. Superparamagnetic iron oxide-enhanced MRI at 3 T for accurate axillary staging in breast cancer. Br J Surg 2016; 103: 326-31. Karanlik H, Cabioglu N, Oprea AL, et al. Sentinel lymph node biopsy may prevent unnecessary axillary dissection in patients with inflammatory breast cancer who respond to systemic treatment. Breast Care (Basel) 2021; 16: 468-74. Mathelin C, Lodi M. Narrative review of sentinel lymph node biopsy in breast cancer: a technique in constant evolution with still numerous unresolved questions. Chin Clin Oncol 2021; 10: 20. Nakagawa M, Morimoto M, Takechi H, Tadokoro Y, Tangoku A. Preoperative diagnosis of sentinel lymph node (SLN) metastasis using 3D CT lymphography (CTLG). Breast Cancer 2016; 23: 333-8. Shiozawa M, Kobayashi S, Sato Y, et al. Magnetic resonance lymphography of sentinel lymph nodes in patients with breast cancer using superparamagnetic iron oxide: a feasibility study. Breast Cancer 2014; 21: 42-7. Saidha NK, Aggarwal R, Sen A. Identification of sentinel lymph nodes using contrast-enhanced ultrasound in breast cancer. Indian J Surg Oncol 2018; 9: 356-9. Shimazu K, Ito T, Uji K, et al. Identification of sentinel lymph nodes by contrast-enhanced ultrasonography with sonazoid in patients with breast cancer: a feasibility study in three hospitals. Cancer Med 2017; 6: 1077-85. He PS, Li F, Li GH, Guo C, Chen TJ. The combination of blue dye and radioisotope versus radioisotope alone during sentinel lymph node biopsy for breast cancer: a systematic review. BMC Cancer 2016; 16: 107. Yuan L, Qi X, Zhang Y, et al. Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective single-center randomized study. Cancer Biol Med 2018; 15: 452-60. Motomura K, Inaji H, Komoike Y, et al. Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients. J Surg Oncol 2001; 78: 28-33. Takahashi M, Sasa M, Hirose C, et al. Clinical efficacy and problems with CT lymphography in identifying the sentinel node in breast cancer. World J Surg Oncol 2008; 6: 43. Yamamoto S, Suga K, Maeda K, Maeda N, Yoshimura K, Oka M. Breast sentinel lymph node navigation with three-dimensional computed tomography–lymphography: a 12-year study. Breast Cancer 2016; 23: 782-7. Motomura K, Sumino H, Noguchi A, Horinouchi T, Nakanishi K. Sentinel nodes identified by computed tomography-lymphography accurately stage the axilla in patients with breast cancer. BMC Med Imaging 2013; 13: 28. Minohata J, Takao S, Hirokaga K. Sentinel lymph node biopsy using CT lymphography in breast cancer. Breast Cancer 2011; 18: 179-83. Li J, Chen X, Qi M, Li Y. Sentinel lymph node biopsy mapped with methylene blue dye alone in patients with breast cancer: A systematic review and metaanalysis. PLoS One 2018; 13: e0194779. Kataria K, Srivastava A, Qaiser D. What is a false negative sentinel node biopsy: definition, reasons and ways to minimize it? Indian J Surg 2016; 78: 401-7. Zhong J, Sun D, Wei W, et al. Contrast-enhanced ultrasound-guided fine-needle aspiration for sentinel lymph node biopsy in early-stage breast cancer. Ultrasound Med Biol 2018; 44: 1401-7.