Study of the Lymphatic Circulation Features in Nodular and Edematous Breast Cancers using the Fluorescence Method to Evaluate the Potential of the Sentinel Lymph Node Detection Technique; Изучение особенностей лимфообращения при узловой и отечной форме рака молочной железы с использованием флуоресцентного метода для оценки возможности применения методики определения сторожевого лимфатического узла

Introduction. Breast cancer (BC) accompanied by edema is one of the most aggressive types of malignant tumor. This type of BC is characterized by specific clinical signs. Fluorescence diagnostics using indocyanine green are actively used to perform biopsies on the ‘sentinel’ lymph node in the treatment of nodular BC. There is potential for its use in the edematous form. This method can be used to visualize the lymphatic drainage pathways of the breast and study their characteristics. Aim. To study the features of lymph drainage in the breast in edematous and nodular cancer using fluorescence diagnostics. Materials and Methods. The study included patients with nodular BC stage I-IIB cT1-3N0 (n = 35) and edematous form stage IIIB cT4bN0-1 (n = 35) who underwent intraoperative lymphography using fluorescence diagnostics with the lymphotropic dye indocyanine green. Results. The average age of patients with nodular BC was 49 ± 0.54 years, and with edematous BC was 53 ± 0.71 years. Having analyzed the lymphography images obtained, we categorized the types of lymph drainage into four types. In nodular and edematous forms, the lymphatic circulation of the breast differed in both lymph drainage variants and structural distribution. Exclusively in the edematous form of BC, diffuse and mixed lymph drainage types were observed. The linear type was present in both groups, but it was significantly more prevalent in nodular cancers, for which the number of main ‘pathways’ in this type was notably higher. Conclusion. Fluorescence diagnostics can also be used to determine the boundaries of breast skin edema intraoperatively. This can help to achieve intact resection boundaries or solve certain diagnostic problems. The technical feasibility of using the sentinel lymph node biopsy method in the edematous form of BC depends on the type of lymphatic circulation. © 2025 Elsevier B.V., All rights reserved.