Surgical Treatment Of Breast Cancer Research Articles

Comprehensive Surgical Treatment of Breast Cancer by Minimally Invasive Surgery

Introduction: The skin and nipple sparing mastectomy is a technique currently on the rise. It arises for the treatment of benign breast lesions; but with the high worldwide incidence of breast cancer, it is used in risk-reducing surgery and breast cancer. In this perspective, numerous technical modifications are described for the minimally invasive surgical approach through low visibility accesses in breast cancer surgery. Objective: To present a technical modification for the Skin-Sparing Modified Radical Mastectomy with preservation of the nipple areola complex and immediate reconstruction with implants by Minimally Invasive Surgery. Methods: We present three patients with left breast cancer operated on for Skin-Sparing Left Modified Radical Mastectomy with preservation of the nipple areola complex and immediate reconstruction with placement of retropectoral implants by minimally invasive surgery through a single periareolar incision. Results: Skin-Sparing Left Modified Radical Mastectomy was performed with preservation of the nipple areola complex and immediate reconstruction with retropectoral prosthesis by minimally invasive surgery in three patients. The evolution was favorable, with good clinical and aesthetic results, without complications and with a high degree of satisfaction according to the international Breast Q scale. Conclusion: Minimally invasive surgery with single periareolar access is safe and effective for Skin-Sparing Radical Mastectomy with preservation of the nipple areola complex, as well as the axilla approach and immediate reconstruction with the placement of retropectoral breast implants.

Влияние оперативного лечения и неоадъювантной терапии химически индуцированного рака молочной железы на корреляционные взаимосвязи концентрации цитокинов лимфы со структурными преобразованиями в брыжеечных лимфатических узлах

We performed a correlation analysis of the morphometry of mesenteric lymph nodes and cytokines of the thoracic duct lymph in chemically induced breast cancer (BC) and after surgical treatment of BC and neoadjuvant chemotherapy for BC according to the CMF scheme. After surgical treatment, correlations were found between the level of cytokines in the thoracic duct lymph and morphological changes in the mesenteric lymph nodes. The observed correlations can be a result of total resection of the tumor and increased immunomodulatory and antitumor action of cytokines. Comparison of the effect of chemotherapy and surgical treatment revealed correlations between cytokine concentrations in the lymph and structural changes in the lymph nodes, which can be related to weakening of local immunity and antitumor effect of cytokines.

Surgical Treatment After Neoadjuvant Systemic Therapy in Young Women With Breast Cancer

We aimed to investigate eligibility for breast conserving surgery (BCS) pre- and post-neoadjuvant systemic therapy (NST), and trends in the surgical treatment of young breast cancer patients. Young women with breast cancer are more likely to present with larger tumors and aggressive phenotypes, and may benefit from NST. Little is known about how response to NST influences surgical decisions in young women. The Young Women's Breast Cancer Study, a multicenter prospective cohort of women diagnosed with breast cancer at age ≤40, enrolled 1302 patients from 2006 to 2016. Disease characteristics, surgical recommendations, and reasons for choosing mastectomy among BCS-eligible patients were obtained through the medical record. Trends in use of NST, rate of clinical and pathologic complete response, and surgery were also assessed. Of 1117 women with unilateral stage I-III breast cancer, 315 (28%) received NST. Pre-NST, 26% were BCS eligible, 17% were borderline eligible, and 55% were ineligible. After NST, BCS eligibility increased from 26% to 42% (P < 0.0001). Among BCS-eligible patients after NST (n = 133), 41% chose mastectomy with reasons being patient preference (53%), BRCA or TP53 mutation (35%), and family history (5%). From 2006 to 2016, the rates of NST (P = 0.0012), clinical complete response (P < 0.0001), and bilateral mastectomy (P < 0.0001) increased, but the rate of BCS did not increase (P = 0.34). While the proportion of young women eligible for BCS increased after NST, many patients chose mastectomy, suggesting that surgical decisions are often driven by factors beyond extent of disease and treatment response.

Initial Surgical Treatment for Breast Cancer and the Distance Traveled for Care.

Geography may influence the operative decision-making in breast cancer treatment. This study evaluates the relationship between distance to treating facility and the initial breast cancer surgery selected, identifying the characteristics of women who travel for surgery. Utilizing Florida state inpatient and ambulatory surgery databases, we identified female breast cancer patients who underwent surgical treatment from January 1 to December 31, 2013. Patients were subgrouped by distance to treatment facility. The primary outcome was the initial surgical treatment choice. Regression models were used to identify factors associated with greater distance to initial treatment. The final sample included 12786 patients who underwent lumpectomy, mastectomy alone, or mastectomy with reconstruction. Compared to women who traveled < 4.0miles, women who traveled > 14.0miles were younger (P < .001), more often identified as white with private insurance (P < .001) and were less likely to have three or more medical comorbidities (P < .001). With increased travel to treatment, the frequency of lumpectomy decreased (P < .001), while the frequency of mastectomy with reconstruction increased (P < .001). Increasing age in years (adjusted odds ratio (AOR) = .98 [95% CI = .98-.99]) and identifying as nonwhite with private (AOR = .70 [.61-.80]) or public insurance (AOR = .64 [.56-.73]) was associated with less frequently travelling for initial breast cancer surgery. The relationship between the initial surgical treatment for breast cancer and the distance traveled for care highlights a disparity between those who can and cannot travel for treatment.

Dexmedetomidine as an adjuvant for patients undergoing breast cancer surgery: A meta-analysis.

Background:The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis.Methods:Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software.Results:Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = −0.65) and morphine (total: SMD = −2.23; patient-controlled analgesia: SMD = −1.45) as well as intraoperative requirement for fentanyl (SMD = −1.60), and lower the pain score at 1 (SMD = −0.30), 2 (SMD = −1.45), 4 (SMD = −2.36), 6 (SMD = −0.63), 8 (SMD = −2.47), 12 (SMD = −0.81), 24 (SMD = −1.78), 36 (SMD = −0.92), and 48 (SMD = −0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05).Conclusion:DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.

Factors that Influence Treatment Delay for Patients with Breast Cancer.

The diagnosis or treatment of breast cancer is sometimes delayed. A lengthy delay may have a negative psychological impact on patients. The aim of our study was to evaluate the sociodemographic, clinical and pathological factors associated with delay in the provision of surgical treatment for localised breast cancer, in a prospective cohort of patients. This observational, prospective, multicentre study was conducted in ten hospitals belonging to the Spanish national public health system, located in four Autonomous Communities (regions). The study included 1236 patients, diagnosed through a screening programme or found to be symptomatic, between April 2013 and May 2015. The study variables analysed included each patient's personal history, care situation, tumour history and data on the surgical intervention, pathological anatomy, hospital admission and follow-up. Treatment delay was defined as more than 30days elapsed between biopsy and surgery. Over half of the study population experienced surgical treatment delay. This delay was greater for patients with no formal education and among widows, persons not requiring assistance for usual activities, those experiencing anxiety or depression, those who had a high BMI or an above-average number of comorbidities, those who were symptomatic, who did not receive NMR spectroscopy, who presented a histology other than infiltrating ductal carcinoma or who had poorly differentiated carcinomas. Certain sociodemographic and clinical variables are associated with surgical treatment delay. This study identifies factors that influence surgical delays, highlighting the importance of preventing these factors and of raising awareness among the population at risk and among health personnel.

Dermatologic sequelae of breast cancer: From disease, surgery, and radiation

The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.

Axillary surgery for breast cancer: past, present, and future.

In breast cancer surgery, there has been a major shift toward less invasive local treatment. Although axillary lymph node dissection (ALND) was an integral part of surgical treatment for breast cancer, sentinel lymph node (SLN) biopsy was developed as an accurate method for axillary staging. ALND can be avoided not only in patients with negative SLNs but also in those with one or two positive SLNs receiving breast and/or axillary radiation. On the other hand, ALND has remained the standard treatment for patients with clinically positive nodes. However, axillary reverse mapping (ARM) was developed to map and preserve arm lymphatic drainage during ALND and/or SLN biopsy. This procedure allowed reduction of the rate of arm lymphedema without increasing axillary recurrence, although patients receive postoperative chemotherapy and high-risk patients undergo axillary radiation. Standard ALND may not be necessary even for patients with clinically positive nodes who receive axillary radiation and systemic therapy. Thus, the extent of axillary surgery in breast cancer has been decreased with increased use of systemic and radiation therapy.

Correlation between HER2 expression before neoadjuvant treatment and RCB classification after surgical treatment in breast cancer

Objective: To explore the relationship between the expression of human epidermal growth factor receptor 2 (HER2) in core needle biopsy (CNB) specimens before neoadjuvant chemotherapy (NAC) and post NAC Residual Cancer Burden (RCB) classification in breast cancer. Methods: This retrospective study included 150 patients with CNB proven invasive breast carcinoma in the Fourth Hospital of Hebei Medical University from January 2013 to January 2014. Immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) was used to detect the expression of HER2 in the CNB specimens. RCB was used to assess the chemotherapy response of patients. SPSS 21.00 and GraphPad Prism 8.0.1 were used for data statistics; Chi square test and Fisher's exact test for correlation analysis, and Cox regression for survival analysis. P<0.05 was considered statistically significant. Results: Among the 150 patients, there were 38 RCB-0, 12 RCB-Ⅰ, 61 RCB-Ⅱ and 39 RCB-Ⅲ post NAC. RCB-0 meant pathological complete response (PCR). Statistical analysis found that the pre NAC HER2 expression was related to PCR and RCB classification after surgery (r1=‒0.217,r2=‒0.282;P<0.05). Further analysis demonstrated that in the HER2-positive group, PCR was associated with prolonged OS and DFS (HR=2.939, 2.359; P<0.05); the differences of OS and DFS in RCB classifications were more significant (P<0.05) in the HER2 positive than HER2 negative groups. Conclusion: There is a correlation between pre NAC HER2 expression and PCR and RCB classification after treatment. In HER2-positive patients, the prognostic stratification of RCB classification is more obvious, suggesting that pre NAC HER2 overexpression combined with RCB classification after surgery can more accurately predict the prognosis.

Lysine-urethane-based tissue adhesion for mastectomy\u2014an approach to reducing the seroma rate?

PurposePostoperative seromas are a problem in the surgical treatment of breast cancer. The aim of the study was to evaluate whether the lysine-urethane-based tissue adhesive TissuGlu® without drainage is equal/ non-inferior to standard mastecomy with drainage.MethodsThe study was designed as a prospective, randomized, multicentre non-inferiority study comparing the use of TissuGlu® without drainage with standard wound care with a drain insertion in ablative breast procedures. The number of clinical interventions, quality of life and wound complications were followed-up for 90 days in both groups.ResultsAlthough the statistical power was not reached, twice as many clinical interventions were performed in the TissuGlu® group than in the drainage group, especially aspirations of clinically relevant seromas (p = 0.014). The TissuGlu® group produced overall less wound fluid, but developed a clinically relevant seroma (100% vs. 63%) which made an intervention necessary. Less hospitalisation time was observed in the TissuGlu® group, but the complication rate was higher. There was no significant difference in regards to postoperative pain. In summary the non-inferiority of TissuGlu® compared to standard drainage couldn’t be reached.DiscussionThe present evaluation shows no advantage of the tissue adhesive TissuGlu® in terms of seroma formation and frequency of intervention compared to a standard drainage for mastectomies, but the shorter inpatient stay certainly has a positive effect on the quality of life.

Independent Predictors of Venous Thromboembolism in Patients Undergoing Reconstructive Breast Cancer Surgery.

Breast cancer is a hypercoagulable state and predisposes patients to venous thromboembolism (VTE). We sought to determine independent risk factors for VTE post-surgical treatment for breast cancer using a national risk adjusted database. Participant Use Data Files in the National Surgical Quality Improvement Program database from 2012 to 2016 were studied. Female patients with invasive and in situ breast cancer that underwent either mastectomy with immediate breast reconstruction, autologous or implant-based, or lumpectomy were identified with current procedural terminology and International Classification of Diseases-9 codes. Venous thromboembolism was defined as occurrence of deep vein thrombosis or pulmonary embolism. Non-VTE and VTE groups were compared and statistical differences were addressed through propensity score weighting. The balance of the model was checked with comparing standardized differences before and after weighting. Multivariate logistic regression was used to determine independent predictors of VTE. A total of 137 449 procedures were identified. After applying exclusion criteria, 40 986 lumpectomies and 35 909 mastectomies remained for the analysis (n = 76 895). Venous thromboembolism was found in 172/76 895 patients (0.2%). In the weighted data set, mastectomy, BMI> 35 and length of stay >3 days were predictors of VTE. The greatest odds ratio (OR) was observed with mastectomy with immediate autologous breast reconstruction (OR = 8.792, P < .001; 95% CI: 3.618-21.367). Autologous breast reconstruction was associated with highest risk of VTE. Hospital LOS >3 days, BMI >35, and general anesthesia also increase odds of developing VTE. These variables are predisposing factors that need to be considered in patients undergoing surgical treatment for breast cancer.

Assessment of the quality of life in breast cancer depending on the surgical treatment.

The objective of the study is to describe QoL in women who have undergone surgical treatment for breast cancer (BC). The focus of the description is the differences in QoL between women treated by modified radical mastectomy (MRM) and women who underwent breast-conserving surgery (BCS) at the Breast and Endocrine Surgery Department of the Clinical Center of Niš, Serbia. From January 1, 2014, until December 31, 2017, 300 patients were treated with BCS and 300 patients with MRM. To assess the QOL, a total of 600 BC patients completed the WHOQOL-BREF questionnaires. The results were analyzed using the t test and chi-square test. WHOQOL produces a quality of life profile. It derives four domain scores: physical health, psychological, social relationships, and environment. Social and demographic factors (age, education, marital status) were collected in both groups. In all four domains, patients treated with conserving surgeries scored higher than patients treated with radical mastectomy. This result was controlled for a set of demographic variables. The differences in QoL scores are present on all levels of controlling variables. According to the results of this study, the QoL in women after an MRM is significantly lower than the QoL in women after BCS. It is especially true for the environment domain. Conserving surgery should be recommended and specific, and patient-centered interventions for increasing QoL of the patients who opted for radical mastectomy should be designed. The intervention should focus on social and environmental domains.

Sacubitril/valsartan versus candesartan in women with heart failure receiving adjuvant therapy for breast cancer - is there any antiarrhythmic effect?

Purpose. To compare the effects of sacubitril/valsartan and candesartan on the occurrence and course of heart arrhythmias in the standard treatment of heart failure (HF) in patients with breast cancer receiving anthracycline antibiotics as part of adjuvant polychemotherapy. Methods. The study involved 127 women aged 53 to 65 who received radical surgical and subsequent treatment for breast cancer in the MAMME clinic in Krasnodar in 2017-2020. Patients were prescribed adjuvant polychemotherapy, including anthracyclines, from 6 cycles. After randomization, standard HF therapy was carried out simultaneously with chemotherapy using sacubitril/valsartan (n=63) or candersartan (n=64). Initially, after the first, third and last courses of special cancer therapy, the heart rate was assessed using standard electrocardiography, 24-hour Holter monitoring of the electrocardiogram, transthoracic echocardiography, a 6-minute walk test were performed, and the level of the N-terminal pro-B type natriuretic peptide and high-sensitivity cardiac troponin I, the Minnesota Quality of Life Questionnaire for patients with chronic HF was completed.Results. According to the 24-hour Holter monitoring of the electrocardiogram, the burden of ventricular premature contraction significantly decreased in the sacubitril/valsartan group (p=0.018), but not in candesartan group (p=0.326). The proportion of patients with persisting episodes of unstable ventricular tachycardia was also significantly reduced in patients randomized to take sacubitril/valsartan (p=0.027), but practically did not change in the candesartan group (p=0.785). Physical exercise tolerance, a 6-minute walk distance, and a quality of life indicator significantly improved only in the sacubitril/valsartan group. According to echocardiography, sacubitril/valsartan improved systolic function of the left ventricle, and candesartan only prevented its decline under the influence of the damaging effects of chemotherapy.Conclusion. The efficacy and safety of treating patients who received cardiotoxic adjuvant chemotherapy for breast cancer, a decrease in the burden of ventricular arrhythmias, noted in the sacubitril/valsartan group, were a consequence of the intensification of treatment for HF. The cardiotoxic effect of anthracyclines can be overcome thanks to the pronounced positive neurohumoral effects of modern pharmacotherapy of HF using sacubitril/valsartan, which leads to a limitation of myocardial remodeling.

Financial Toxicity Following Surgical Treatment for Breast Cancer: A Cross-sectional Pilot Study.

Despite growing national attention, there is limited understanding of the patient- and treatment-level characteristics related to treatment cost-associated distress ("financial toxicity") in breast cancer patients. Our aim is to identify risk factors for financial toxicity amongst breast cancer patients undergoing surgical treatment. This is a single-institution cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 and June 2019. Financial toxicity was measured via the 11-item comprehensive score for financial toxicity (COST) instrument. Responses were linked with data on patient demographics and clinical history abstracted from the corresponding medical record. Multivariate regression was used to identify patient- and treatment-level factors associated with worsening financial toxicity. Secondary outcome measures included self-reported coping strategies for high treatment costs. A total of 571 patients were included; overall, these individuals were mostly white (76.0%), in-state residents (72.3%), and married (73.0%). Following multivariate analysis, lower financial distress was associated with the use of supplemental insurance, increasing annual household income, and a higher credit score (score > 740). Conversely, work reduction or cessation, increased out-of-pocket spending, advanced tumor stage, and being employed at the time of diagnosis were associated with increased financial distress. Patients with higher reported financial distress were more likely to decrease their spending on food, clothing, and leisure activities. Financial toxicity was associated with baseline demographic, disease, and treatment characteristics in our cohort of insured patients. These characteristics may be critical opportunities for interventions related to financial navigation along the treatment continuum.

The surgical treatment of breast cancer: A journey, not a procedure.

The surgical treatment of breast cancer: A journey, not a procedure.

526 Poster - A prospective analysis of patient-reported outcomes within breast cancer surgical treatment strategies

Background: Although patient-reported outcomes (PROs) are increasingly assessed within breast cancer care, there is limited knowledge about short-term PRO scores following various surgical treatments. This study sought to investigate short-term PRO scores in breast cancer patients after either breast-conserving therapy (BCT) or conventional mastectomy.

Assessment of Postural Balance in Women Treated for Breast Cancer.

Background and objectives: Surgery is the primary and most effective treatment of breast cancer. Unilateral mastectomy disrupts the distribution of muscle tension between the right and the left sides of the body. The aim of the study was to evaluate postural balance in patients treated for breast cancer by mastectomy. Materials and methods: A controlled clinical study was conducted on 90 patients who have undergone surgical treatment for breast cancer (mastectomy) 5–6 years prior (Breast Group—BG). The control group (CG) consisted of 74 healthy female volunteers. Analysis of balance was performed using the Alfa stabilography platform. A static test (Romberg’s test) with open and closed eyes was used to assess balance. The following balance parameters were analyzed: path length, statokinesigram area, parameters of deflection and velocity of the foot pressure center. Results: The study demonstrated that patients from BG (5–6 years after surgery) obtained worse results in both tests with open (maximum back deviation, maximum forward deviation, average Y deviation, average Y velocity, path length and path surface area) (p < 0.05) as well as with closed eyes (maximum backward deviation, maximum forward deviation, mean Y deviation and path length) (p < 0.05). Conclusions: Our study demonstrated that women 5–6 years after surgery for breast cancer have impaired balance compared to healthy women, despite physiotherapy.

How breast cancer treatments affect the quality of life of women with non-metastatic breast cancer one year after surgical treatment: a cross-sectional study in Greece

BackgroundThe continuously increasing survivorship of female breast cancer makes the monitoring and improvement of patients’ quality of life ever so important. While globally there is a growing body of research on health-related quality of life 1 year after surgical treatment for non-metastatic breast cancer, up-to-date information regarding Greek patients is scarce.ObjectiveTo measure the level of QoL of non-metastatic BC survivors in Greece 1 year after surgery.MethodsA sample of 200 female breast cancer survivors aged 18 to 75, who followed up as outpatients in five public hospitals were included in this cross-sectional study. All recruited patients agreed to participate in the study (100% response rate). Quality of life data were collected through the EORTC QLQ-C30 as well as BR23 questionnaires.ResultsCronbach’s alpha for all scales of the two questionnaires was from 0.551 to 0.936 indicating very good reliability. According to the Multiple Linear Regression, older patients showed a lower future perspective (p = .031), with those living in rural areas, which was associated with more financial difficulties (p = .001). Women with tertiary education and those who had been hospitalized in a university hospital recorded better on global health status (p = .003 and .000 respectively). Patients who underwent chemotherapy reported better scores in the emotional function sub-scale (p = .025). Women with reconstruction and at least one complication appeared to have significantly better scores in future perspective and social function (p = .005, .002 respectively).ConclusionsBreast cancer survivors were found to have an overall good quality of life, functioning/symptoms scores and were satisfied with the provided care.

Future perspectives of surgical treatment of breast cancer

Breast cancer is a heterogenous disease which requires updates on scientific research to offer patients the best possible and personalized treatment. Modern surgical treatment of breast cancer is recently been reviewed and it is clearly a field of continuous change and improvement. The change in treatment strategies is a challenge given that prognosis is already acceptable. The collaboration between specialties across different countries is needed to exchange experience and improve international guidelines. Multidisciplinary teams are mandatory for the patient to be provided with all treatment options and to make an informed decision on their treatment. The major trend in surgical treatment of breast cancer is de-escalating surgery and more focus on tumor biology. A “one-size-fits all” approach does not apply in treatment of breast cancer today. There are two major questions in future aspects of breast cancer treatment; Can surgery in the breast be omitted in patients with a pathological complete response after neoadjuvant therapy? And can some patients be spared axillary surgery? The timing of surgery is also debatable. These are major questions that need to be answered and through randomized controlled trials. This commentary gives an insight on thoughts and scientific research with focus on future aspects of breast cancer treatment.

Identification of Sentinel Lymph Node in Breast Cancer with three Tracers (Radiocolloid, Methylene blue, and Indocyanine Green). (Case Report)

BACKGROUND: Sentinel lymph node (SNL) biopsy in breast cancer for the determination of axillary status is standard procedures in surgical treatment of early-stage breast cancer. The identification of the SNL is usually performed by radiocolloid injection or/and injection of methylene blue due. The use of indocyanine green (ICG) dye, which is fluorescent dye, which movement in breast and axillar pit, can be followed with special cameras which detect near infrared specatar of light.&#x0D; CASE REPORT: In this paper, we present case report of patient with breast cancer, where we perform SNL detection with three methods: Use of radiocolloid which we trace with static gamma camera, and intraoperatively with hand held gamma probe, methylene blue dye which movement we followed by eye contact and using indocyanine green which movement was followed by specially constructed multispectral camera, which can detect near-infrared fluorescence that is emitted by ICG and methyline blue, respectively.&#x0D; CONCLUSION: Fluorescent imaging with ICG is a sensitive, valuable, and safe method for SNL biopsy. Finding new agents that would identify the SNL, especially if they are not radioactive would be an important step in wider application of this method.