Preoperative localization of sentinel lymph node in breast cancer patients by silver wire insertion or liquid charcoal injection guided by CT lymphography

Abstract

Dual localization of SLN in breast cancer patients using isotope & dye is the best‐approved modality with limitations such as high cost of radioactive materials, complex logistic preparations & scheduling issues, especially in developing countries. We investigated the feasibility & accuracy of a novel technique for SLN localization using silver wire insertion or liquid charcoal injection guided by CT lymphography. 120 patients with clinically node‐negative breast cancer were enrolled. In the test group, SLN was localized using preoperative CTLG guided injection of liquid charcoal or by placing a 3 cm silver wire. In addition, intraoperative SLN mapping was performed using methylene blue dye followed by searching for the SLN localized by both methods. In the control group, SLN was localized by the blue dye only. Feasibility, accuracy, detection rates, and number of SLNs retrieved were reported as well as matching between the LN detected with the CTLG and that detected with the dye technique. SLN could be detected in 59 out of 60 patients (98.3%) in the test group and in 54 out of 60 patients (90%) in the control group (P = .057). In self‐controlled analysis of the test group comparing CTLG only to dye only was significant (P = .050). Comparing charcoal to silver wire in detection was statistically insignificant (P = .5). This novel method can offer advantages which are as follows: being more accurate than the dye alone, saving operative time, abandoning complex logistic preparations for the radioisotope, and solving the problem of timing.

Advanced diagnostic imaging of sentinel lymph node in early stage breast cancer

“…It can well describe the lymphatic channel and can be used to visualize the SLNs and breast lymphatic drainage pathways; thus, providing important clinical significance for understanding the anatomy of the lymphatic tract and SLNs before surgery. [26][27][28]30 5 | TRANS-LYMPHATIC CONTRAST-ENHANCED ULTRASOUND (TLCEUS)…”

“…Compared with the combined staining of methylene blue and indocyanine green, the accuracy of preoperative CTLG followed by CT three‐dimensional reconstruction to locate SLN and lymphatic vessels was 92.6%, and the accuracy of SLN number was 95.2% (Figure 4). 29 It was reported that the preoperative recognition rate of SLN detection using liquid carbon suspension and silver wire guided CTLG was 100%, and the intraoperative recognition rate was 98.3% 30 . In addition, studies on gadolinium‐loaded polyvinyl imide coated gold nanoparticles 31,32 as CT/MR dual‐mode contrast agents can make up for the deficiencies of single imaging examination in evaluating SLN properties.…”

“…The posture during CTLG detection is the same as that during surgery, and the position of SLNs should not change. It can well describe the lymphatic channel and can be used to visualize the SLNs and breast lymphatic drainage pathways; thus, providing important clinical significance for understanding the anatomy of the lymphatic tract and SLNs before surgery 26–28,30 …”

“… 29 It was reported that the preoperative recognition rate of SLN detection using liquid carbon suspension and silver wire guided CTLG was 100%, and the intraoperative recognition rate was 98.3%. 30 In addition, studies on gadolinium‐loaded polyvinyl imide coated gold nanoparticles 31 , 32 as CT/MR dual‐mode contrast agents can make up for the deficiencies of single imaging examination in evaluating SLN properties. In short, CTLG has a high sensitivity and a low negative rate in the diagnosis of SLNs.…”

Impact of Imaging Biomarkers and AI on Breast Cancer Management: A Brief Review

“…Axillary nodal metastasis: When staging axillary lymph nodes (ALNs), sentinel node biopsy (SNB) remains the gold standard [158]. It is defined as the initial site to receive breast lymphatic drainage and represents the primary location for ALN infiltration [159,160]. This sentinel node can be identified using various methods, including blue dye, radioisotopes, ICG (indocyanine green), or their combination, and subse-quently retrieved intraoperatively for histopathological examination to determine the necessity for ALN dissection [160].…”