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Title: Endoscopic Breast-Conserving Surgery with Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer: Initial Indian ExperiencePon Jeeva Mathan1 Keshavarajan Gandhirajan2, Jagadesh Chandra Bose3
Department of surgical oncology, Dr.Rela Hospital, Chennai, India
Abstract
Background
Endoscopic breast-conserving surgery (EBCS) seeks to improve cosmetic outcomes while preserving oncological safety. Although widely reported in East Asia, the technique is rarely documented in India. We present an initial Indian series of EBCS combined with sentinel lymph node biopsy (SLNB) performed through a single concealed axillary incision.
Methods
Between January and March 2025, three women with biopsy-proven, clinically node-negative early invasive breast carcinoma underwent EBCS with SLNB. A single axillary incision was used for resection and axillary staging with CO₂ insufflation and ultrasonic dissection. Outcomes included operative parameters, complications, margin status, cosmetic satisfaction, and short-term oncologic follow-up.
Results
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All cases were completed endoscopically without conversion. Mean operative time was 145 minutes and mean blood loss 60 ml. All margins were negative. One patient developed a minor seroma managed conservatively. Median hospital stay was one day. Cosmetic satisfaction averaged 4.6/5. At a median follow-up of 6 months, all patients remained disease-free.Conclusion
EBCS with SLNB is feasible and safe in carefully selected Indian patients, providing high cosmetic satisfaction with oncologic adequacy in the short term. Larger series with longer follow-up are required.
Keywords:
endoscopic breast surgery
breast-conserving surgery
sentinel lymph node biopsy
minimally invasive
cosmesis
India
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Introduction
Breast-conserving surgery (BCS) with radiotherapy achieves survival outcomes comparable to mastectomy for early-stage disease. However, conventional BCS often leaves visible scars, affecting quality of life and body image. Endoscopic-assisted techniques allow concealed incisions with preservation of oncologic principles, with Asian reports demonstrating feasibility, oncologic safety, and improved cosmetic satisfaction. In India, experience with EBCS remains limited. We report the first Indian series of three patients undergoing EBCS with SLNB.
Patients and Methods
Patient Selection
Between January and March 2025, three women with core-biopsy confirmed invasive carcinoma were selected. Inclusion: tumor ≤ 3 cm, unifocal disease, node-negative, preference for EBCS. Exclusion: multifocal disease, contraindications to conservation, or refusal of endoscopic surgery.
Surgical Technique
A 3–4 cm axillary incision was created. CO₂ insufflation (6–8 mmHg) provided working space. Dissection was performed with a 30° endoscope and ultrasonic device. The tumor was resected with a rim of normal tissue and extracted via the axillary incision. SLNB was performed through the same incision using blue dye, radioisotope, and/or indocyanine green (ICG). Margins were assessed on frozen section when indicated and confirmed on final pathology.
Outcomes
Demographics, operative time, blood loss, complications, conversion, hospital stay, margin status, cosmetic satisfaction (5-point Likert scale), and short-term oncologic follow-up were recorded.
Results
All three cases were completed endoscopically. Mean operative time: 145 min; mean blood loss: 60 ml. All margins negative. One seroma occurred, managed conservatively. No wound infection or lymphedema. Median hospital stay: 1 day. Cosmetic satisfaction averaged 4.6/5. At 6-month median follow-up, all patients were disease-free.
Case Summaries
Case | Age | Histology | Receptors | Ki-67 | Size (cm) | Nodes | Stage | Adjuvant |
|---|---|---|---|---|---|---|---|---|
1 | 60 | Tubular carcinoma | ER+/PR+, HER2– | 3–4% | 0.6×0.5 | 0/1 SLNB | pT1bN0 | RT |
2 | 50 | IDC, Grade III | ER+, PR–, HER2– | 60–70% | 1.5×1.5 | 0/15 (SLNB + clearance) | pT1cN0 | CT + Endocrine + RT |
3 | 50 | IDC, Grade III | Triple negative | > 95% | 1.9×1.1×1.0 | 0/1 SLNB | pT1cN0 | CT + RT |
| CT – Chemotherapy, RT – Radiotherapy, ER – Estrogen Receptor, PR- Progesterone Receptor, Her 2 – Human Epidermal growth factor 2, IDC – Invasive Ductal carcinoma | ||||||||
Parameter | Case 1 | Case 2 | Case 3 |
|---|---|---|---|
Age (years) | 60 | 50 | 50 |
Presentation | Screening (BI-RADS IV) | Palpable lump | Screening (BI-RADS IV) |
Tumour Location | Left upper outer quadrant | Right lower quadrant (6–7 o’clock) | Right upper quadrant (12 o’clock) |
Histology | Invasive tubular carcinoma | IDC, Grade III | IDC, Grade III |
ER / PR / HER2 | ER+/PR+, HER2– | ER+, PR–, HER2 FISH– | Triple negative |
Ki-67 (%) | 3–4 | 60–70 | > 95 |
Tumour Size (cm) | 0.6 × 0.5 | 1.5 × 1.5 | 1.9 × 1.1 × 1.0 |
DCIS | Absent | Present | Absent |
Lymph Node Status | 0/1 (SLNB) | 0/15 (SLNB + clearance) | 0/1 (SLNB) |
Pathological Stage | pT1bN0 | pT1cN0 | pT1cN0 |
Adjuvant Therapy | RT | CT + Hormonal + RT | CT + RT |
Follow-Up Status | Well | Well | Well |
CT – Chemotherapy, RT – Radiotherapy, ER – Estrogen Receptor, PR- Progesterone Receptor, Her 2 – Human Epidermal growth factor 2, IDC – Invasive Ductal carcinoma
Discussion
This early Indian series demonstrates the feasibility of single-incision EBCS with SLNB. Findings mirror East Asian reports: high cosmetic satisfaction, negative margins, and no short-term recurrence. Operative times were longer, consistent with the learning curve. SLNB with ICG through the same incision is comparable to open techniques, supporting combined oncologic and aesthetic benefits. Limitations include small sample size and short follow-up. Future multicenter studies and standardized PROMs are needed.
Conclusion
EBCS with SLNB is a safe and feasible option in selected Indian patients with early-stage breast cancer. It offers oncological adequacy while significantly improving cosmetic outcomes.
Declarations
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Consent: All patients provided informed consent for surgery and publication of anonymized data/images.A
Funding:
This research received no external funding.
Conflict of interest: The authors declare no conflicts of interest.
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Author Contribution
D Pon jeeva mathan was responsible for conceptualisation, methodology, writing- original draft, writing- review and editing, and visualisation. The author read and approved the final manuscript.
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Clinical trial number: not applicable.Acknowledgements:
The authors thank the surgical team and nursing staff for their support.
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