The clinical significance signal lymph node biopsy using indocyanine green after effective neoadjuvant chemotherapy with target therapy with early sporadic early HER2 positive breast cancer

According to the International Agency for Research on Cancer GLOBOCAN (Cancer Today), breast cancer ranks first in the structure of mortality from cancer among women. In recent decades, there has been a steady trend in the treatment of breast cancer to minimize the volume of radical surgical treatment in order to improve the quality of patients lives and comply with the principles of oncological adequacy. A sentinel lymph node biopsy (SLNB) is an alternative to axillary lymphatic dissection in patients with clinically intact regional lymph nodes (cN0). This allows patients to avoid such formidable and often disabling complications of lymphatic dissection as – prolonged postoperative lymphorrhea and lymphatic swelling of the upper extremity (lymphostasis). Thanks to SLNB in combination with neoadjuvant therapy (NAT), which is most effective in HER2-positive tumors, the number of patients who underwent organ-preservation surgical treatment is steadily increasing. World trends go further and in the range of studies an attempt to abandon the implementation of SLNB has already been made in some groups of patients with early breast cancer. This article analyzes the experience and results of performing a fluorescent signal lymph node biopsy using indocyanine green after effective neoadjuvant polychemotherapy with target therapy in patients with early sporadic HER2-positive breast cancer in the oncology department of Botkin Hospital.

1. Cancer Today. https://gco.iarc.fr/today/home

2. Breast Cancer. Clinical Recommendations. 2021. Available at: https://cr.minzdrav.gov.ru/schema/379_4. (In Russ.)

3. Fisher B., Montague E., Redmond C. et al. Findings from NSABP protocol No. B-04 – comparison of radical mastectomy with alternative treatments for primary breast cancer. Cancer. 1980;46(1):1–13.

4. Breast Cancer. NCCN Guidelines. Version 4.2020.

5. Makris A, Powles TJ, Ashley SE. A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer PMID: 9862047 https://doi.org/10.1023/a:1008400706949

6. Jean-Marc Classe, Cecile Loaec, P Gimbergues. Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study. PMID: 30343457 https://doi.org/10.1007/s10549-018-5004-7

7. Hiroko Nogi, Ken Uchida, Rei Mimoto. Long-Term Follow-Up of Node-Negative Breast Cancer Patients Evaluated via Sentinel Node Biopsy After Neoadjuvant Chemotherapy. PMID: 28601382 https://doi.org/10.1016/j.clbc.2017.05.002

8. Oluwadamilola M Fayanju, Yi Ren, Samantha M Thomas . The Clinical Significance of Breast-only and Node-only Pathologic Complete Response (pCR) after Neoadjuvant Chemotherapy (NACT): A Review of 20,000 Breast Cancer Patients in the National Cancer Data Base (NCDB). PMCID: PMC6496955 NIHMSID: NIHMS1012817 PMID: 30048319.

9. Титов К.С., Лебединский И.Н., Куц И.Н. и др. Биопсия сигнального лимфатического узла флуоресцентным методом с индоцианином зеленым при раннем раке молочной железы: Опыт ГКБ им. С.П. Боткина г. Москвы. Опухоли женской репродуктивной системы. 2024;20(1):52–8. https://doi.org/https://doi.org/10.17650/1994-4098-2024-20-1-52-58

10. Valente S.A., Al-Hilli Z., Radford D.M. Near infrared fluorescent lymph node mapping with indocyanine green in breast cancer patients: A prospective trial. J Am Coll Surg. 2019; 228:672–8. https://doi.org/10.1016/j.jamcollsurg.2018.12.001

11. Jinno H., Inokuchi M., Ito T. et al. The Japanese Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer, 2015 edition. Breast Cancer. 2016;23:367–77. https://doi.org/10.1007/s12282-016-0671-x

12. Sugie T., Ikeda T., Kawaguchi A. et al. Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer: A meta-analysis. Int J Clin Oncol. 2017;22:11–7. https://doi.org/10.1007/s10147-016-1064-z

13. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial Oreste Davide Gentilini 1 2, Edoardo Botteri 3 4, Claudia Sangalli 5 PMID: 37733364 PMCID: PMC10514873 https://doi.org/10.1001/jamaoncol.2023.3759

14. Straver M.E. et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS Trial. Ann. Surg. Oncol. 2010;17:1854-1861.