Immunofluorescence and targeted removal of the axillary sentinel lymph node in early-stage breast cancer: a simple, safe and effective anatomical approach

The reference technique for axillary sentinel lymph node (SLN) detection in women with breast cancer uses the radioactive marker, technetium (Tc99m), which makes ambulatory surgery difficult and carries a risk of irradiation to the patient and the medical teams. The aim of this study was to investigate the feasibility of using immunofluorescence (IF), a new non-radioactive technique, for SLN detection in women with early-stage breast cancer (ESBC). Patients were included if they were suffering from ESBC (T1/T2 N0) or ductal carcinoma in situ. The SLN was first detected using IF with indocyanine green and was then confirmed using Tc99m. A total of 268 women with ESBC were included (median age: 61.4 years). Tumour location in the breast correlated with SLN location according to the anatomic classification ABCD, with >75% of tumours located in the outer quadrants of the breast. IF was positive in 96% of cases and allowed precise anatomic location of the SLN. The SLN was located in zone A in 87.7% of patients and zone B in 10.1%, which corresponds to the path of the lateral thoracic vein. Only 2.2% of tumours were in zone C and none were in zone D. Rate of failure of detection by IF alone was 4.1%, associated with a mean BMI of 26.8 kg/m 2 . IF is an economic, non-invasive, non-radioactive technique for SLN detection in ESBC. Surgeons should be aware of this new, alternative procedure so that it can be used more widely in the future.