Axillary lymph node dissection (ALND) has been the standard treatment of breast cancer axillary staging in Indonesia. The limited facilities of radioisotope tracer and isosulfan or patent blue dye (PBD) have been the major obstacles to perform sentinel node biopsy (SNB) in our country. We studied the application of 1% methylene blue dye (MBD) alone for SNB to overcome the problem. This prospective study enrolled 108 patients with suspicious malignant lesions or breast cancer stages I–III. SNB was performed using 2–5 cc of 1% MBD and proceeded with ALND. The histopathology results of sentinel nodes (SNs) were compared with axillary lymph nodes (ALNs) for diagnostic value assessments. There were 96 patients with invasive carcinoma from July 2012 to September 2014 who were included in the final analysis. The median age was 50 (25–69) years, and the median pathological tumor size was 3 cm (1–10). Identification rate of SNs was 91.7%, and the median number of the identified SNs was 2 (1–8). Sentinel node metastasis was found in 53.4% cases and 89.4% of them were macrometastases. The negative predictive value (NPV) of SNs to predict axillary metastasis was 90% (95% CI, 81–99%). There were no anaphylactic reactions, but we found 2 cases with skin necrosis. The application of 1% MBD as a single technique in breast cancer SNB has favorable identification rates and predictive values. It can be used for axillary staging, but nevertheless the technique should be applied with attention to the tumor size and grade to avoid false negative results.

Background: Breast cancer treatment-related lymphedema (BCRL) is a chronic progressive morbidity for which a definitive cure has not yet been achieved. Since axillary lymph node dissection (ALND) is the main risk factor, we have studied the pattern of lymphatic drainage and subclinical lymphedema progression with ICG lymphography (ICG-L) after ALND as a part of our strategy to prevent BCRL. Methods: This study was a prospective cohort of breast cancer patients who underwent ALND between October 2022 and August 2024. We prospectively evaluated postoperative lymphatic drainage with ICG-L. Subclinical lymphedema progression to lymphedema was analyzed using the Kaplan–Meier method. Results: Sixty-three patients were analyzed. Five classifications of lymphatic pathways were identified. The most prevalent pattern was arm and chest wall dermal backflow (DB), draining to internal mammary nodes or type III in 54% of cases, followed by arm DB and collateral drainage to clavicular nodes (type II) in 19.1%, and arm DB only (type I) in 14.3% cases. The cumulative incidence of subclinical lymphedema progression to BCRL was 71.7% [95% confidence interval (CI), 47.0–96.4] with a median BCRL incidence of 13.8 months (95% CI, 10.0–17.5). The hazard rate of BCRL reached its peak at 3 and 12 months. Conclusion: The lymphatic drainage pattern of the arm will mainly drain into the internal mammary and clavicular nodes after ALND. A substantial number of subclinical cases progressing to early-stage BCRL can be detected by ICG-L within the first year. This finding could be used to develop strategies for BCRL prevention.

Objective: This study aimed to investigate the associations of CD8+, PARP, and EGFR expressions with two-year survival in patients with triple-negative breast cancer (TNBC). Methods: A retrospective cohort study was conducted in a national cancer center. All patients aged 18 years diagnosed with TNBC (2013-2017) were included and followed for 24 months or until the patients were deceased. Kaplan-Meier survival function and Cox proportional hazard model were applied for the analyses. Results: The study population was followed for 24 months (2,692 person-months, N = 126). At the end of the follow-up, 27 patients were deceased. The two-year mortality rate was 10 per 1,000 person-month. Kaplan-Meier graphs showed that after approximately one year of follow-up, poorer survival was seen in patients with low CD8+, positive PARP, and positive EGFR. The adjusted analysis found staging as the main predictor of overall survival in TNBC (HR = 7.20, 95% CI= 2.07 – 25.00). Conclusions: Patients with low CD8+, positive PARP, and positive EGFR expressions seem to be associated with poorer overall survival in TNBC. After approximately one year of follow-up, higher survival was observed in patients with high CD8+, negative PARP, and negative EGFR. Staging remains the main predictor of TNBC survival. Therefore, early detection and treatment of TNBC are essential to improve survival.

Background/Objectives: Breast cancer-related lymphedema (BCRL) is one of the major morbidity in breast cancer. Since lymphedema treatment is difficult, especially once it progresses, screening and early detection should be prioritized to prevent the progression. This study used indocyanine green lymphography (ICG-L) as a sensitive diagnostic tool for BCRL screening after axillary lymph node dissection (ALND). Methods: This prospective cohort study included breast cancer patients who underwent ALND from October 2022 to October 2024 at Dharmais National Cancer Hospital. ICG-L was performed to diagnose BCRL. Our study outcome was a 2-year BCRL cumulative incidence and ICG-L stage distribution. Results: This study included 69 patients with a mean body mass index of 26.3±5.1 kg/m2. The median (IQR) of dissected lymph nodes was 18 (14-21), with the number of lymph node metastases 2 (0-10). Forty-six patients (66.7%) were in the locally advanced stage and 42 (60.9%) received radiotherapy. Based on ICG-L, our 2-year BCRL cumulative incidence was 58.0% (45.2-71.4). A total of 25 patients (71.4%) who had BCRL experienced symptoms, with heaviness (60%) and swelling (48%) being the most common signs. The upper extremity lymphedema index increase of > 10 % was only found in 11 (31.4%) patients. Most patients were in ICG-L stage II, as shown in 18 (51.4%) subjects. Conclusions: ICG-L was able to detect early BCRL more frequently. This finding showed its sensitivity as a screening method and that it should be used in preventive BCRL management.