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Purpose: This study aims to determine the optimal time to perform sentinel lymph node biopsy (SLNB) for patients with clinically node-negative (cN 0 ) disease following neoadjuvant chemotherapy (NAC)., Method: From April 2008 to April 2018, 592 patients with breast cancer underwent after NAC were included in this study. Patients with cN 0 before and ycN 0 disease after NAC received SLNB and axillary lymph node dissection (ALND) in case of positive sentinel lymph nodes (SLNs). For patients with clinically node-positive (cN + ) disease, the axillary surgery is based on the doctor's decision., Result: In general, 17.6% (104/592) of patients achieved total pathologic complete response (pCR), which was 6.9%, 33.3%, 32.3% and 15.3%, respectively, among patients with hormone receptor (HR) positive/ human epidermal growth factor receptor-2 (HER-2) negative (HR+/HER2-) subtype, triple-negative (TN) subtype, HER-2 positive (HER2+) subtype with and without targeted therapy (p < 0.001). Among the 525 cN + patients, the axillary nodal pCR (apCR) rate was 34.5%, and the apCR rate was significantly higher in patients with HER2+ (58.6% with and 28.2% without targeted therapy respectively) and TN subtype (53.2%) than that in patients with HR+/HER2-subtype (21.2%, p < 0.001). Among the 67 cN 0 patients, the positive rate of SLNs was 19.4% (13/67), which was 28.1% (9/32), 13.3% (2/15) and 10.0% (2/20), respectively, among patients with HR+/HER2-, TN and HER2 + subtypes., Conclusion: The pCR rates were significantly related to molecular subtype. Combining the apCR rates in different molecular subtypes of cN + patients and the excellent locoregional control of AOSOG Z0011 and AMAROS trials in cN 0 patients, it would be preferable to perform SLNB prior to NAC for cN 0 patients with HR+/HER2- subtype, and SLNB after NAC for those cN 0 patients with TN and HER2+ subtype to increase the chance of avoiding ALND. Among cN 0 patients, TN and HER2 + subtypes would benefit more from axillary de-escalating surgery after NAC than HR+/HER2- subtype.

Objective: The aim of this study was to determine the impact of routinely performed internal mammary sentinel lymph node biopsy (IM-SLNB) on the staging and treatment, and to analyze the success rate, complications and learning curve., Methods: All patients with biopsy-proven breast cancer who underwent sentinel lymph node biopsy between 2012 and 2014 were included in a prospective analysis. Internal mammary sentinel lymph node biopsy (IM-SLNB) was performed in all patients with IM-SLN visualized on preoperative lymphoscintigraphy and/or detected by intraoperative gamma probe detection. The adjuvant treatment plan was adjusted according to the current guidelines., Results: In a total of 349 patients, 249 patients (71.1%) showed internal mammary drainage. IM-SLNB was performed in 153 patients with internal mammary drainage, with a success rate of IM-SLNB of 97.4% (149/153). Pleural lesion and internal mammary artery bleeding were found in 7.2% and 5.2% patients, respectively. In 8.1% of patients (12/149) the IM-SLN was tumor positive. In the group of patients who underwent IM-SLNB, lymph node staging was changed in 8.1% of patients, and IMLNs radiotherapy was guided by these results, however, systemic treatment was changed in only 0.7% of the patients., Conclusions: IM-SLNB has a high successful rate and good safety. Identification of internal mammary metastases through IM-SLNB may provide more accurate staging and guide the tailored internal mammary radiotherapy., Trial Registration: ClinicalTrials. gov, NCT01642511.

Background and purpose: Both domestic and foreign guidelines recommend the use of radionuclide as sentinel lymph node (SLN) biopsy (SLNB) tracer, however this technique has not been popularized in China for a variety of reasons. Mitoxantrone hydrochloride injection for tracing (MHI), a new strategy to identify lymph nodes, has not been tested for axillary node staging in breast cancer. This multicenter, self-controlled, non-inferiority trial aimed to evaluate the differences between MHI and radionuclide in SLNB tracing. Methods: The trial was conducted across 7 hospitals from December 2019 to December 2020. Patients with early-stage breast cancer received MHI and radionuclide (technetium 99 labeled sulfur colloid, 99mTc-Sc) as SLN tracers during the surgery. The number of SLNs detected and sentinel node detection rates of MHI and radionuclide were counted to evaluate differences in the tracing effects between the two tracers. Results: SLN detection rates of MHI and radionuclide were 96.9% (370/382) and 97.4% (372/382), respectively, with no significant difference (P>0.05). SLNs were co-detected by both tracers in 362 (94.7%) patients; 16 (4.1%) had adverse events possibly related to the trial drugs. Conclusion: In this study, it was found that the lymphatic tracing ability of MHI was not inferior to that of radionuclide. Meanwhile, the use of MHI does not require special instrument/ equipment assistance. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common malignant tumor in women, and its incidence is increasing year by year. Regional lymph node metastasis status is an important prognostic indicator of breast cancer. Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as the standard method to identify regional lymph node metastasis in early-stage breast cancer patients. The current guidelines recommend blue dye and nuclear methods as the standard sentinel lymph node (SLN) tracing methods. The ideal SLN tracer should be visualized, targeted and reproducible, supported by evidence-based medical evidence, easy to use and inexpensive with minimal adverse effects. Currently, the tracers can be broadly divided into visual tracers and contrast tracers, with the former including cyanine dyes such as methylene blue, carbon nanomaterials such as carbon nanosuspensions, and mitoxantrone for tracing; the latter including nucleophiles, fluorescent tracers such as indocyanine green, magnetic tracers such as superparamagnetic iron oxide, and ultrasound contrast agents such as sulfur hexafluoride microbubbles. All these tracers have certain limitations, such as lack of targeting of methylene blue, low fluorescence penetration of indocyanine green, and radioactive contamination of nucleophiles. For this reason, many studies have been conducted on the development and improvement of new tracers for SLN of breast cancer. Photoacoustic imaging (PAI) is a new imaging technique utilizing photoacoustic effect, in which biological endogenous chromophores or exogenous contrast agents absorb pulsed light to cause local thermoelastic expansion and subsequently radiate ultrasonic waves outward, forming a biological tissue light energy absorption difference distribution map and imaging. The PAI technique can be used to evaluate the morphology and function of labeled tissues through photoacoustic contrast agents and their coupling groups. In this paper, we reviewed the progress of PAI and its contrast agent application in SLNB, focusing on the small molecule NIR dyes, metallic nanomaterials and carbon nanomaterials. At the same time, we discussed the research of new targeted fluorescent tracer formed after combining small molecule near-infrared dyes with molecular antibodies as a common ligand. At last, we presented the future perspectives in this field. [ABSTRACT FROM AUTHOR]