Abstract P4-02-18: Sentinel node biopsy mapping using fluoresceine in breast cancer. An alternative for low and middle income countries
Authors: Salmon Remy Jacques , Benna Mehdi 
Published: March 2020

Abstract
Background: All methods available for SNB identification suffer from many flaws including cost of the probes, allergies or management of radioactive material. Breast cancer is a challenging issue in LMIC [1]. Fluorescein has been described first in this meeting [2-3] as an alternative cheap and safe tracer in SNB mapping [4]. Our aim was to reproduce the feasibility and the safety of fluorescein SNB mapping compared with Isosulfan blue dye as a reference.
Methods: Ten patients, with biopsy proven BC, were operated on for SNB biopsy and prospectively included over a period of one year (April 2018 - April 2019). Patients had 2 cc Isosulfan blue dye and 2 cc 10% fluorescein mixed with 4 cc of 9% saline solution injected subcutaneously in the peri-areolar area prior to lymph node biopsy. Fluorescent lymph nodes were detected by 5 nm ultra-violet light-emitting diode flashlight. They were removed and then remaining blue and/or suspicious nodes were removed.
The detection rate and the complications were the primary objectives in this study.
Results: Mean age was 40 years old (range 27 - 72). Mean size of the tumor was 20 mm (5 - 70mm). All patients but one had invasive breast carcinoma and one had ductal carcinoma in situ. All patients had no clinical or radiological suspicious nodal involvement before surgery. Six patients had a breast conserving surgery and four had a mastectomy. After a mean delay of 15,5 minutes after injection, SLN sampling was performed. All patients had fluorescent and blue nodes. A total of 27 fluorescent nodes and 25 blue nodes were harvested during these procedures. All blue nodes were fluorescent. Two nodes had micro-metastasis on final pathology. One of them was only detected by fluorescein. Adverse effects were represented by 2 seromas. No patient experienced an allergic reaction.
Conclusion: In this pilot study, we were able to reproduce the published data where fluorescein based SNB detection was feasible, efficient in the detection rate and safe. We emphasize the need for a larger multicenter study to confirm the clinical utility of this tracer. The low cost of this technique will greatly help the development of SNB in LMIC
Refernces:
1. Bellanger M, Zeinomar N, Tehranifar P, Terry MB. Are Global Breast Cancer Incidence and Mortality Patterns Related to Country-Specific Economic Development and Prevention Strategies? JGO. 8 juin 2018;(4):1-16.
2. Srivastava A, Suresh J, Ranjan P, et al: Fluorescent fluorescein with methylene blue compared to radioactive sulphur colloid with methylene blue: a randomised comparison. Proc SABCS 2017; abstr PD2-03.
3. Srivastava A, Kumar C,Kataria K fluorescence guided breast conserving surgery Proc SABCS 2018 PD 08 06
4. Chang YW, Lee HY, Lee CM, Jung SP, Kim WY, Woo SU, et al. Sentinel lymph node detection using fluorescein and blue light-emitting diodes in patients with breast carcinoma: A single-center prospective study. Asian Journal of Surgery [Internet]. 20 mars 2019.
Citation Format: Remy Jacques Salmon, Mehdi Benna. Sentinel node biopsy mapping using fluoresceine in breast cancer. An alternative for low and middle income countries [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-18.