Assessment of Metastatic Status of Axillary Lymph Nodes using Intravenous Fluorescein in Carcinoma Breast
A Novel Approach in Surgical Management
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 node
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