ArticleAnnals of surgical oncology2025
Clinical Application of Multimodal Sentinel Lymph Node-Mapping Method for Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy: A Final Analysis.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNeoadjuvant chemotherapy (NAC) leads to a nodal pathologic complete response (pCR) in approximately 70% of breast cancer patients, especially in human epidermal growth factor receptor 2 (HER2)-positive and triple-negative subtypes. However, sentinel lymph node (SLN)-mapping after NAC remains challenging due to lower identification and higher false-negative rates compared with early-stage breast cancer. This study aimed to evaluate the efficacy of a multimodal SLN-mapping approach after NAC.
methodsThis prospective, single-center, randomized controlled trial enrolled 270 patients with breast cancer receiving NAC between May 2021 and July 2024 and randomized them (1:1:1) to arm A (radioisotope [RI] + indocyanine green fluorescence [ICG-F]), arm B (RI + vital dye [indigo carmine]), and arm C (ICG-F + vital dye). The primary outcome of SLN-identification rate and the secondary outcome of SLN-operation time were analyzed.
resultInterim results showed SLN-identification rates of 95% in arm A, 92% in arm B, and 79% in arm C, with a significant difference between arms A and C (0.1597; p = 0.0055). The final analysis comparing only arms A and B showed SLN-identification rates of 92.6% (100/108) and 90.6% (96/106), respectively (p = 0.2967), with a significantly shorter mean time to first SLN detection in arm B than in arm A (7 vs. 8 min; p = 0.0046). The intra-arm detection rates differed significantly: arm A (RI, 96.0%; ICG-F, 92.0%; p = 0.232) versus arm B (RI, 97.9%; vital dye, 72.9%; p < 0.0001).
conclusionMultimodal SLN-mapping demonstrated high post-NAC identification rates without significant intra-arm differences in the SLN-identification rates, whereas SLN-detection rates differed by the method for each arm. For patients with breast cancer, RI + ICG-F SLN-mapping is an effective dual-method post-NAC approach.
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