Comparison of Single Incision and Separate Incision Techniques in Sentinel Lymph Node Biopsy for Breast Cancer

Background: Breast cancer is the most common malignancy among Thai women, with approximately 50 new cases per 100,000 population annually. Sentinel lymph node biopsy (SLNB) is crucial for staging early breast cancer, and the choice of surgical technique can significantly impact outcomes. Identification of SLN using blue dye alone simplifies the procedure while remaining effective for resource-limited hospitals lacking frozen section analysis. Prior studies of single-incision SLNB focused on breast-conserving surgery. Objective: This pilot study aimed to compare the single-incision and separate-incision techniques for SLNB in breast cancer patients, focusing on node harvesting, operative time, and postoperative complications. Materials and Methods: Data were collected from Ubonratchatani Cancer Hospital between 2020 and 2024. A total of 59 patients with early-stage, clinically node-negative breast cancer were included: 31 underwent SLNB via the single-incision technique, and 28 via the separate-incision technique. Patients with biopsy-proven axillary node metastasis or those who received neoadjuvant chemotherapy were excluded. Multivariable regression analysis was used to assess key factors influencing node harvesting. Results: The single-incision technique led to a 46% and 40% increase in lymph node yield compared to the separate-incision method in mastectomy with breast-conserving surgery and mastectomy alone, respectively. Operative times were shorter for the single-incision group, and postoperative complications, including seroma and wound infection, were less frequent. Tumor location, HER-2 status, and histologic grade significantly affected node harvesting. Both techniques showed comparable safety profiles, but the single-incision approach demonstrated improved surgical efficiency. Additionally, both techniques yielded similar survival outcomes, with no statistically significant differences in short-term overall survival and progression-free survival. Conclusion: The single-incision technique for SLNB benefits node harvesting and operative efficiency while maintaining comparable postoperative complication rates. These findings suggest that the single-incision method may enhance patient outcomes, but further research is needed to validate these results and explore long-term oncological benefits.