This is a retrospective observational study comparing the accuracy and safety of robotic-assisted versus endoscopic-assisted sentinel lymph node biopsy (SLNB) in patients with breast cancer. The study aims to evaluate the detection accuracy, false-negative rate, and perioperative safety profile between the two minimally invasive techniques, as well as to assess postoperative complications, pain, upper limb function, quality of life, and long-term oncological outcomes including axillary recurrence and survival. Data will be extracted from routine clinical records. The study will compare the robotic group and the endoscopic group with respect to the following outcome measures: 1.Accuracy-related outcomes: sentinel lymph node detection rate, number of sentinel lymph nodes identified, and false-negative rate, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). All accuracy metrics are calculated with reference to final axillary lymph node status confirmed by completion ALND or long-term clinical follow-up; 2.Safety-related outcomes: perioperative parameters including operative time, estimated blood loss, length of hospital stay, and duration of postoperative drainage; postoperative complications including but not limited to seroma, hematoma, wound infection, and lymphedema; postoperative pain assessed by the Verbal Rating Scale (VRS); upper limb function assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) score; and quality of life assessed by the Functional Assessment of Cancer Therapy - Breast + 4 (FACT B+4) questionnaire; 3.Oncological outcomes: including but not limited to axillary recurrence, locoregional recurrence, distant metastasis, disease-free survival (DFS), and overall survival (OS), with a minimum follow-up period to be determined based on data availability. This study has been approved by the Research Ethics Committee of Guangzhou Medical University Affiliated Women and Children's Medical Center. A waiver of informed consent has been granted due to the retrospective nature of the study. All patient data will be anonymized and kept confidential. Statistical analyses will be performed using R, SPSS and GraphPad Prism, with a P value \< 0.05 considered statistically significant.
Study Type
OBSERVATIONAL
Enrollment
150
Guangzhou Women and Children's Medical Center, Guangzhou Medical University
Guangzhou, Guangdong, China
Accuracy Outcomes
Sentinel lymph node biopsy (SLNB) accuracy is comprehensively evaluated in patients undergoing robotic-assisted or endoscopic-assisted SLNB for breast cancer. The following accuracy metrics are assessed: (1) false-negative rate (calculated among patients with confirmed axillary lymph node metastasis, defined as the proportion of SLNB-negative patients who have positive non-sentinel nodes on completion axillary lymph node dissection); (2) sensitivity (the proportion of patients with axillary metastasis who have a positive SLNB); (3) specificity (the proportion of patients without axillary metastasis who have a negative SLNB); (4) negative predictive value (NPV); and (5) positive predictive value (PPV).
Time frame: Perioperative, at final pathology after completion axillary lymph node dissection
Sentinel Lymph Node Detection Rate
The sentinel lymph node (SLN) detection rate is defined as the percentage of patients in whom at least one SLN is successfully identified and pathologically confirmed as lymph node tissue. SLN localization is performed using indocyanine green (ICG) or carbon nanoparticle tracing. The detection rate is compared between the robotic-assisted and endoscopic-assisted SLNB groups.
Time frame: Perioperative, at final pathology
Number of Sentinel Lymph Nodes Identified Per Patient
The number of sentinel lymph nodes (SLNs) identified per patient is recorded intraoperatively and confirmed by postoperative pathology as lymph node tissue. SLN localization is performed using indocyanine green (ICG) or carbon nanoparticle tracing. The mean number of SLNs identified per patient is compared between the robotic-assisted and endoscopic-assisted SLNB groups.
Time frame: Perioperative, at final pathology
Postoperative Complications
The incidence of postoperative complications is compared between the robotic-assisted and endoscopic-assisted groups, including but not limited to: seroma, hematoma, wound infection, surgical site infection, lymphedema of the ipsilateral upper extremity, shoulder dysfunction, and other procedure-related adverse events. All complications are graded according to the Clavien-Dindo classification system.
Time frame: Within 30 days post-surgery and at long-term follow-up assessments
Recurrence and Metastasis Events
The incidence of axillary recurrence, locoregional recurrence, and distant metastasis is compared between the robotic-assisted and endoscopic-assisted groups, with all events confirmed by histopathological or radiological evidence.
Time frame: Up to 5 years post-surgery, with follow-up duration based on data availability from routine clinical records
Survival Outcomes
Disease-free survival (DFS), defined as time from surgery to first recurrence, metastasis is compared between the two groups.
Time frame: Up to 5 years post-surgery, with follow-up duration based on data availability from routine clinical records
Operative Time
Operative time (minutes) is compared between the robotic-assisted and endoscopic-assisted sentinel lymph node biopsy groups.
Time frame: Intraoperative
Intraoperative Blood Loss
Intraoperative Blood Loss(mL) is compared between the robotic-assisted and endoscopic-assisted sentinel lymph node biopsy groups.
Time frame: Intraoperative
Length of hospital stay
Length of hospital stay (days) is compared between the robotic-assisted and endoscopic-assisted groups.
Time frame: Perioperative
Duration of postoperative drainage
Duration of postoperative drainage (days) is compared between the robotic-assisted and endoscopic-assisted groups.
Time frame: Perioperative
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