Assessment of Metastatic Status of Axillary Lymph Nodes using Intravenous Fluorescein in Carcinoma Breast
A Novel Approach in Surgical Management
DOI:
https://doi.org/10.21467/preprints.382Abstract
Background: Assessment of lymph node metastasis is of prime significance for staging and treatment planning for breast cancer. All enlarged lymph nodes do not contain metastasis. Sentinel lymph nodes biopsy is recommended for patients with clinically negative axilla. But there are no standard guidelines for managing patients with enlarge axillary lymph node. In the present paper we have evaluated the role of intravenous Fluorescein to identify the axillary nodal metastasis during axillary dissection.
Aim: Identification of metastatic fluorescent node during axillary dissection.
Methodology: The present cross-sectional study at All India Institute of medical sciences on 32 operable carcinoma breast cases were enrolled in the study. Fluorescent and non-fluorescent nodes were sent separately for histopathological evaluation.
Result: Present study include a total of 32 cases. From these 32 cases a total of 267 lymph nodes were separated out in which 185 nodes were fluorescent and 82 nodes were non fluorescent. Out of 267 fluorescent node 103 were histologically positive and remaining nodes were free of tumor. In non-fluorescent nodes only 6 nodes show the presence of tumor.
Conclusion: Intravenous 20% fluorescein sodium has a high sensitivity of 94.5% & specificity of 48% with positive predictive value of 55.7%, which is comparable to conventional sentinel lymph node procedure in detecting early metastasis. Besides time saving and non-toxic, this technique predicts the metastatic status of axillary lymph node during surgery, aiding appropriate surgical intervention.
Keywords:
Fluorescence imaging, Breast cancer, Sodium Fluorescein, Axillary lymph nodeDownloads
References
WHO, “Cancer Fact Sheets,” World Health Organization, Feb. 03, 2022. https://www.who.int/news-room/fact-sheets/detail/cancer (accessed Apr. 21, 2022).
Globocan, “Cancer Tomorrow,” The Global Cancer Observatory, 2020. https://gco.iarc.fr/tomorrow/en (accessed Apr. 21, 2022).
WHO, “Breast Cancer Fact Sheets,” World Health Organization, Mar. 26, 2021. https://www.who.int/news-room/fact-sheets/detail/breast-cancer (accessed Apr. 21, 2022).
A. Khokhar, “Breast cancer in India: where do we stand and where do we go?,” Asian Pac. J. Cancer Prev., vol. 13, no. 10, pp. 4861–4866, Jan. 2012, doi: 10.7314/APJCP.2012.13.10.4861.
A. Shankar et al., “Change in trend in various clinico-pathological factors and treatment profile of breast cancer patients: A tertiary cancer centre experience,” Asian Pacific J. Cancer Prev., vol. 17, no. 8, 2016.
B. Rangarajan et al., “Breast cancer: An overview of published Indian data,” South Asian J. Cancer, vol. 05, no. 03, pp. 086–092, Dec. 2020, doi: 10.4103/2278-330X.187561.
P. Li and D. Sun, “Advanced diagnostic imaging of sentinel lymph node in early stage breast cancer,” J. Clin. Ultrasound, vol. 50, no. 3, pp. 415–421, Mar. 2022, doi: 10.1002/JCU.23151.
H. S. Cody, “Sentinel lymph node mapping in breast cancer,” Breast Cancer 1999 61, vol. 6, no. 1, pp. 13–22, Jan. 1999, doi: 10.1007/BF02966901.
U. Veronesi et al., “A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer,” http://dx.doi.org/10.1056/NEJMoa012782, vol. 349, no. 6, pp. 546–553, Oct. 2009, doi: 10.1056/NEJMOA012782.
M. Noguchi, “Is it necessary to perform prospective randomized studies before sentinel node biopsy can replace routine axillary dissection?,” Breast Cancer 2003 103, vol. 10, no. 3, pp. 179–187, Jul. 2003, doi: 10.1007/BF02966716.
D. N. Krag, D. L. Weaver, J. C. Alex, and J. T. Fairbank, “Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe,” Surg. Oncol., vol. 2, no. 6, pp. 335–340, Dec. 1993, doi: 10.1016/0960-7404(93)90064-6.
A. E. Giuliano, D. M. Kirgan, J. M. Guenther, and D. L. Morton, “Lymphatic mapping and sentinel lymphadenectomy for breast cancer.,” Ann. Surg., vol. 220, no. 3, p. 391, 1994, doi: 10.1097/00000658-199409000-00015.
R. Simmons, S. Thevarajah, M. B. Brennan, P. Christos, and M. Osborne, “Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization,” Ann. Surg. Oncol., vol. 10, no. 3, pp. 242–247, 2003, doi: 10.1245/ASO.2003.04.021.
W. D. Blessing, A. J. Stolier, S. C. Teng, J. S. Bolton, and G. M. Fuhrman, “A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping,” Am. J. Surg., vol. 184, no. 4, pp. 341–345, Oct. 2002, doi: 10.1016/S0002-9610(02)00948-0.
K. Motomura, H. Inaji, Y. Komoike, T. Kasugai, S. Noguchi, and H. Koyama, “Sentinel Node Biopsy Guided by Indocyanin Green Dye in Breast Cancer Patients,” Jpn. J. Clin. Oncol., vol. 29, no. 12, pp. 604–607, Dec. 1999, doi: 10.1093/JJCO/29.12.604.
K. Kataria, A. Srivastava, and D. Qaiser, “What Is a False Negative Sentinel Node Biopsy: Definition, Reasons and Ways to Minimize It?,” Indian J. Surg. 2016 785, vol. 78, no. 5, pp. 396–401, Jul. 2016, doi: 10.1007/S12262-016-1531-9.
M. E. Straver et al., “Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial,” Ann. Surg. Oncol., vol. 17, no. 7, pp. 1854–1861, Mar. 2010, doi: 10.1245/S10434-010-0945-Z/TABLES/3.
U. Veronesi et al., “Sentinel lymph node biopsy in breast cancer: Ten-year results: Of a randomized controlled study,” Ann. Surg., vol. 251, no. 4, pp. 595–600, Apr. 2010, doi: 10.1097/SLA.0B013E3181C0E92A.
H. Mabry and A. E. Giuliano, “Sentinel Node Mapping for Breast Cancer: Progress to Date and Prospects for the Future,” Surg. Oncol. Clin. N. Am., vol. 16, no. 1, pp. 55–70, Jan. 2007, doi: 10.1016/J.SOC.2006.10.015.
C. Kahlert et al., “Tumour-site-dependent expression profile of angiogenic factors in tumour-associated stroma of primary colorectal cancer and metastases,” Br. J. Cancer, vol. 110, no. 2, pp. 441–449, Jan. 2014, doi: 10.1038/bjc.2013.745.
G. J. Whitman, R. H. AlHalawani, N. Karbasian, and R. Krishnamurthy, “Sentinel Lymph Node Evaluation: What the Radiologist Needs to Know,” Diagnostics 2019, Vol. 9, Page 12, vol. 9, no. 1, p. 12, Jan. 2019, doi: 10.3390/DIAGNOSTICS9010012.
T. Kitai, T. Inomoto, M. Miwa, and T. Shikayama, “Fluorescence Navigation with Indocyanine Green for Detecting Sentinel Lymph Nodes in Breast Cancer,” Breast Cancer, vol. 12, no. 3, pp. 211–215, Jul. 2005, doi: 10.2325/JBCS.12.211.
D. Qaiser et al., “Detection of tumour containing sentinel lymph node in breast cancer by injection of fluorescence tracer through ‘dual route’ in breast tissue and intravenously,” in PHOTOPTICS 2015 - 3rd International Conference on Photonics, Optics and Laser Technology, Proceedings, 2015, vol. 1, pp. 125–128. doi: 10.5220/0005403401250128.
H. S. Cody and III, “Clinicopathologic Factors Associated With False-Negative Sentinel Lymph-Node Biopsy in Breast Cancer,” Ann. Surg., vol. 244, no. 2, p. 324, Aug. 2006, doi: 10.1097/01.SLA.0000230027.27680.97.
K. Kawada and M. M. Taketo, “Significance and mechanism of lymph node metastasis in cancer progression,” Cancer Res., vol. 71, no. 4, pp. 1214–1218, Feb. 2011, doi: 10.1158/0008-5472.CAN-10-3277/649644/AM/SIGNIFICANCE-AND-MECHANISM-OF-LYMPH-NODE.
H. Takeuchi and Y. Kitagawa, “Sentinel Node and Mechanism of Lymphatic Metastasis,” Ann. Vasc. Dis., vol. 5, no. 3, pp. 249–257, 2012, doi: 10.3400/AVD.RA.12.00033.
R. Roskoski, “Vascular endothelial growth factor (VEGF) signaling in tumor progression,” Crit. Rev. Oncol. Hematol., vol. 62, no. 3, pp. 179–213, Jun. 2007, doi: 10.1016/J.CRITREVONC.2007.01.006.
L. M. Sherwood, E. E. Parris, and J. Folkman, “Tumor Angiogenesis: Therapeutic Implications,” http://dx.doi.org/10.1056/NEJM197111182852108, vol. 285, no. 21, pp. 1182–1186, Jan. 2010, doi: 10.1056/NEJM197111182852108.
J. Folkman, “What is the evidence that tumors are angiogenesis dependent?,” Journal of the National Cancer Institute, vol. 82, no. 1. pp. 4–7, Jan. 03, 1990. doi: 10.1093/jnci/82.1.4.
V. Goh, A. R. Padhani, and S. Rasheed, “Functional imaging of colorectal cancer angiogenesis,” Lancet Oncol., vol. 8, no. 3, pp. 245–255, Mar. 2007, doi: 10.1016/S1470-2045(07)70075-X.
M. S. Gee et al., “Doppler ultrasound imaging detects changes in tumor perfusion during antivascular therapy associated with vascular anatomic alterations,” Cancer Res., vol. 61, no. 7, 2001.
R. Sjöback, J. Nygren, and M. Kubista, “Absorption and fluorescence properties of fluorescein,” Spectrochim. Acta Part A Mol. Biomol. Spectrosc., vol. 51, no. 6, pp. L7–L21, Jun. 1995, doi: 10.1016/0584-8539(95)01421-P.
R. Hochsattel, H. Gall, L. Weber, and R. Kaufmann, “Photoallergic reaction to fluorescein,” Contact Dermatitis, vol. 22, no. 1, pp. 42–44, Jan. 1990, doi: 10.1111/J.1600-0536.1990.TB01504.X.
C. Wolf, K. Greistorfer, and H. Stammberger, “Der endoskopische Nachweis von Liquorfisteln mittels der Fluoreszeintechnik,” Laryngo-Rhino-Otologie, vol. 76, no. 10, pp. 588–594, Oct. 1997, doi: 10.1055/s-2007-997486.
G. L. Kearns, B. J. Williams, and O. D. Timmons, “Fluorescein phototoxicity in a premature infant,” J. Pediatr., vol. 107, no. 5, 1985, doi: 10.1016/S0022-3476(85)80421-2.
R. P. Danis and T. Stephens, “Phototoxic Reactions Caused by Sodium Fluorescein,” Am. J. Ophthalmol., vol. 123, no. 5, pp. 694–696, May 1997, doi: 10.1016/S0002-9394(14)71086-4.
M. R. Stein and C. W. Parker, “Reactions following intravenous fluorescein,” Am. J. Ophthalmol., vol. 72, no. 5, pp. 861–868, 1971, doi: 10.1016/0002-9394(71)91681-3.
M. C. . Aalders, “Aspects of photodetection in cervical and ovarian neoplasia,” Thesis, Chapter 6 University of Amsterdam , UvA DARE, 2001. Accessed: Apr. 21, 2022. [Online]. Available: https://dare.uva.nl/search?identifier=f6123a42-4b25-448a-a71d-09653e53a564
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