Evaluation of the technique of endoscopic axillary sentinel lymph node biopsy in early-stage node-negative breast cancer

Background
Sentinel lymph node (SLN) biopsy has emerged as an alternative to routine axillary node dissection in early-stage node-negative breast cancer. However, there have been controversies in clinical application because of its various identification rates and false-negative rates. We analyzed endoscopic sentinel node biopsy as a feasible procedure for visualization of the axillary space and resection of the sentinel node using endoscopic technique.
Objective
To evaluate the implementation of the technique and to compare the feasibility, effectiveness, outcome, and complications of endoscopic axillary SLN biopsy versus open technique in early-stage breast cancer.
Patients and methods
Between October 2020 and May 2021, 48 patients with breast cancer with clinically node-negative results were injected methylene blue or patent blue dye. A total of 24 female patients underwent endoscopic sentinel node biopsy and 24 female patients underwent the traditional method at the breast unit of Department of Surgery at Cairo University Hospitals. The following were evaluated during the study period: feasibility of technique, seroma formation, shoulder mobility, numbness, and pain at the postoperative site.
Results
In 24 patients undergoing the endoscopic technique using insufflation and minimal instrument dissection, the SLN at level I was inspected at its anatomical site and individual lymph nodes were easily identified. One patient developed lateral chest wall infection in the form of cellulitis (4%). The same patient experienced postoperative seroma. Intercostobrachial nerve affection was seen in 29% in the endoscopic method; however, it was 75% in the open method owing to nerve manipulation, not owing to direct injury.
Conclusion
Using endoscopy, we found that this technique allows (a) a minimally invasive working space, (b) recognition of anatomic landmarks, and (c) instrument manipulation within the axilla to identify and extract lymph nodes and apply the sentinel node technique. In almost every case, an excellent anatomical orientation was achieved. The retrieval rate for the sentinel node in endoscopic technique was 100% as found in the open technique.