preoperative axillary ultrasound-guided wire localization and lymphoscintigraphy for sentinel lymph node biopsy in breast cancer patients

Background: breast cancer has the highest incidence and mortality among femalemalignant tumors. breast cancer with negative axillary lymph nodes has been diagnosedmainly at an early stage. sentinel lymph node biopsy (slnb) is a standardscreening technique for patients with early-stage breast cancer and clinically negativelymph nodes. lymphoscintigraphy (sentinel lymph node mapping) has been regularlyused as the standard method for slnb. today, ultrasound-guided wire localization(usgwl) is a well-established technique with superior outcomes. therefore,we attempted to determine whether preoperative ugwl and lymphoscintigraphy(blue dye and isotope injection) improve sln detection and false-negative rate inbreast cancer patients undergoing slnb and identify clinical factors that may affectthe diagnostic accuracy of axillary ultrasound (aus).methods: between december 2018 and june 2019, 55 patients with clinical t1-3n0 breast cancer eligible for an slnb at imam khomeini hospital in tehran wereincluded in our study. tumor characteristics and demographic data were collectedby reviewing medical records and questionnaires prepared by our surgical team.the day before slnb, all patients underwent ultrasound-guided wire localization ofsln. lymphoscintigraphy was performed with an unfiltered 99mtc-labelled sulfurcolloid peritumoral injection followed by methylene blue dye injection. the resultswere analyzed based on the permanent pathology report.results: among the 55 patients, 71.8% of slns were detected by wire localization,while 57.8% were found by methylene blue mapping and 59.6% by gamma probedetection. compared with wire localization and isotope injection, the methylene bluedye technique had a low sensitivity (72.2%), while both wire localization and isotopeinjection reached 77.8%. the sensitivity, specificity, and accuracy of ugwl were77.8%, 42.1%, and 65.4%, respectively. otherwise, methylene blue dye and isotopeinjection accuracy was 47.3% and 50.1%, respectively. furthermore, there was asignificant relationship between bmi, tumor size, laterality, reactive aln, and theaccuracy of preoperative aus. but there was no significant correlation between age,weight, height, tumor biopsy, tumor location, the time interval between methyleneblue dye and isotope injection to surgery, and also the type of surgery to the accuracyof preoperative aus.conclusion: preoperative ugwl can effectively identify slns compared to lymphoscintigraphy(blue dye and isotope injection) in early breast cancer patients undergoingslnb.