Endoscopic Breast-Conserving Surgery with Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer: Initial Indian Experience

Endoscopic Breast-Conserving Surgery with Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer: Initial Indian Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Endoscopic Breast-Conserving Surgery with Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer: Initial Indian Experience Pon Jeeva Mathan, Keshavarajan Gandhirajan, Jagadesh Chandra Bose This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7565823/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Mar, 2026 Read the published version in BMC Surgery → Version 1 posted 28 You are reading this latest preprint version 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 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. endoscopic breast surgery breast-conserving surgery sentinel lymph node biopsy minimally invasive cosmesis India Figures Figure 1 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 Consent: All patients provided informed consent for surgery and publication of anonymized data/images. Funding: This research received no external funding. Conflict of interest: The authors declare no conflicts of interest. Author contributions: [D. Pon Jeeva Mathan] conceived the study; [D. Pon Jeeva Mathan] performed surgeries; [D. Pon Jeeva Mathan] collected and analyzed data; [D. Pon Jeeva Mathan] drafted the manuscript; all authors reviewed and approved the final version. Clinical trial number: not applicable. Acknowledgements: The authors thank the surgical team and nursing staff for their support. References Li L, Liang Y, Li C, et al. Comparison of endoscopic breast-conserving surgery versus conventional breast-conserving surgery for early-stage breast cancer: a meta-analysis. Front Oncol. 2024;14:1419123. 10.3389/fonc.2024.1419123 . Wang ZH, Gang TR, Wu SS, et al. Single-port endoscopic sentinel lymph node biopsy combined with indocyanine green and carbon nanoparticles in breast cancer. Surg Endosc. 2023;37(10):7591–9. 10.1007/s00464-023-10000-0 . Lai HW, Mok CW, Chang YT, et al. Endoscopy-assisted breast-conserving surgery: outcomes, learning curve, and aesthetics in 100 procedures. Eur J Surg Oncol. 2020;46(8):1446–55. 10.1016/j.ejso.2020.03.222 . Parmar V, Kulkarni D, Badwe RA. Breast conservation surgery and oncoplasty in India. Indian J Med Res. 2021;154(Suppl):S214–23. 10.4103/ijmr.IJMR_2534_20 . Xie F, Wang ZH, Wu SS, et al. Clinical efficacy of single-port insufflation endoscopic breast-conserving surgery versus open breast-conserving surgery. World J Surg Oncol. 2022;20:335. 10.1186/s12957-022-02798-6 . Chia CLK, Sae-lim C, Lai HW, et al. Single-port three-dimensional endoscopic-assisted breast surgery: preliminary results and patient satisfaction. World J Surg Oncol. 2023;21:335. 10.1186/s12957-023-03255-0 . Patrianagara A, Yen Hwe L. Endoscopy-assisted breast-conserving surgery versus conventional breast-conserving surgery: a meta-analysis. Breast Dis. 2023;42(1):383–92. 10.3233/BD-230024 . Wang ZH, Wu SS, Liu Y, et al. Clinical evaluation of indocyanine green fluorescence-guided sentinel lymph node biopsy in breast cancer. Breast Cancer Res Treat. 2021;186(1):123–31. 10.1007/s10549-020-06012-4 . Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for invasive breast cancer. N Engl J Med. 2002;347(16):1233–41. 10.1056/NEJMoa022152 . Noguchi M. Oncoplastic breast surgery: past, present, and future. Breast Cancer. 2015;22(3):185–9. 10.1007/s12282-015-0590-5 . Fan LJ, Jiang J, Yang J, et al. Endoscopy-assisted breast-conserving surgery versus conventional breast-conserving surgery for breast cancer: a meta-analysis. Breast J. 2020;26(6):1234–42. 10.1111/tbj.13959 . Yamagata Y, Shindo M, Sugitani I, et al. Cosmetic outcomes and patient satisfaction after endoscopic-assisted breast-conserving surgery. Breast Cancer. 2019;26(2):212–9. 10.1007/s12282-018-0893-2 . Mathan PJ, Gandhirajan K, Bose JC. Endoscopic breast conservation surgery for early-stage invasive carcinoma: a case report-first case from India. Int Surg J. 2025;12(8):1372–7. https://doi.org/10.18203/2349-2902.isj20252293 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Mar, 2026 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 15 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviews received at journal 13 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviews received at journal 11 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviews received at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers invited by journal 01 Oct, 2025 Editor invited by journal 15 Sep, 2025 Editor assigned by journal 10 Sep, 2025 Submission checks completed at journal 10 Sep, 2025 First submitted to journal 08 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7565823","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":529336139,"identity":"b6600d3a-a89b-4288-bf07-5b771ea8bde8","order_by":0,"name":"Pon Jeeva 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09:15:55","extension":"png","order_by":40,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2143803,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineIMG5505.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/3afdb693365594139ba2aced.png"},{"id":93574328,"identity":"64ee6293-9ce7-471f-9bab-3672fd672a2e","added_by":"auto","created_at":"2025-10-15 09:15:55","extension":"png","order_by":41,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1170657,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineIMG5507.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/8657d8c2255bc3ad77a0cea8.png"},{"id":93575743,"identity":"e29da947-5642-4b86-842a-f4ea806c8377","added_by":"auto","created_at":"2025-10-15 09:23:55","extension":"png","order_by":42,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1804013,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineIMG5508.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/f7880a0f29192fe3487de79f.png"},{"id":93575737,"identity":"65572704-a63c-4b4b-90a1-4014f322c362","added_by":"auto","created_at":"2025-10-15 09:23:54","extension":"png","order_by":43,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1904945,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineIMG5510.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/65831c8238c3073a861cb0b7.png"},{"id":93576344,"identity":"f77b3534-1e1a-438e-a2f2-38980b0b12ec","added_by":"auto","created_at":"2025-10-15 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09:15:55","extension":"png","order_by":46,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2453714,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineIMG5542.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/537e2748a948644e896a6032.png"},{"id":93576345,"identity":"82d6b8ec-2483-4aa5-a251-f7b020834e53","added_by":"auto","created_at":"2025-10-15 09:31:55","extension":"png","order_by":47,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":163392,"visible":true,"origin":"","legend":"","description":"","filename":"OnlinePHOTO20250124155718.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/2d66450ab69e36981ae90f79.png"},{"id":93575752,"identity":"5fc79400-2ac8-4ecc-bfce-ea42126bc701","added_by":"auto","created_at":"2025-10-15 09:23:55","extension":"png","order_by":48,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159619,"visible":true,"origin":"","legend":"","description":"","filename":"OnlinePHOTO20250124155719.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/0932f4c84649b33e187de85a.png"},{"id":93575751,"identity":"d9776160-c82e-4b58-a732-f11aab8e2ea7","added_by":"auto","created_at":"2025-10-15 09:23:55","extension":"png","order_by":49,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30896,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/55a28f7296b0cd86eb5bc1f1.png"},{"id":93575746,"identity":"e51ec657-e03d-4516-8cdd-dd8be9850341","added_by":"auto","created_at":"2025-10-15 09:23:55","extension":"xml","order_by":50,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":41393,"visible":true,"origin":"","legend":"","description":"","filename":"312af8ec007e423ca54413ea0970422d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/267293c55ef6fe8cdc080357.xml"},{"id":93574315,"identity":"af9f14bf-c9e8-4de9-988c-2ff649e00b28","added_by":"auto","created_at":"2025-10-15 09:15:55","extension":"html","order_by":51,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49582,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/6d4427e7dadb0b1495b22859.html"},{"id":93575718,"identity":"60f7f31a-2107-4699-8150-b7820df266f6","added_by":"auto","created_at":"2025-10-15 09:23:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84146,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Results section.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/ec2a26fb5f4bceb483edf2f3.png"},{"id":104739560,"identity":"8d80c67b-d0fd-4dbd-b7c3-b3fd3b11e3ca","added_by":"auto","created_at":"2026-03-16 16:09:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":482895,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7565823/v1/9d71ba9a-c0c7-4bf9-a568-05d9b2baa9f2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEndoscopic Breast-Conserving Surgery with Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer: Initial Indian Experience \u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast-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.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Selection\u003c/h2\u003e\u003cp\u003eBetween January and March 2025, three women with core-biopsy confirmed invasive carcinoma were selected. Inclusion: tumor\u0026thinsp;\u0026le;\u0026thinsp;3 cm, unifocal disease, node-negative, preference for EBCS. Exclusion: multifocal disease, contraindications to conservation, or refusal of endoscopic surgery.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurgical Technique\u003c/h3\u003e\n\u003cp\u003eA 3\u0026ndash;4 cm axillary incision was created. CO₂ insufflation (6\u0026ndash;8 mmHg) provided working space. Dissection was performed with a 30\u0026deg; 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.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eDemographics, operative time, blood loss, complications, conversion, hospital stay, margin status, cosmetic satisfaction (5-point Likert scale), and short-term oncologic follow-up were recorded.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll 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.\u003c/p\u003e\n\u003ch3\u003eCase Summaries\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026times;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReceptors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eKi-67\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSize (cm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNodes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eStage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAdjuvant\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTubular carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eER+/PR+, HER2\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u0026ndash;4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c6\"\u003e\u003cp\u003e0.6\u0026times;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0/1 SLNB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003epT1bN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIDC, Grade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eER+, PR\u0026ndash;, HER2\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60\u0026ndash;70%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c6\"\u003e\u003cp\u003e1.5\u0026times;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0/15 (SLNB\u0026thinsp;+\u0026thinsp;clearance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003epT1cN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCT\u0026thinsp;+\u0026thinsp;Endocrine\u0026thinsp;+\u0026thinsp;RT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIDC, Grade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTriple negative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c6\"\u003e\u003cp\u003e1.9\u0026times;1.1\u0026times;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0/1 SLNB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003epT1cN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCT\u0026thinsp;+\u0026thinsp;RT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eCT \u0026ndash; Chemotherapy, RT \u0026ndash; Radiotherapy, ER \u0026ndash; Estrogen Receptor, PR- Progesterone Receptor, Her 2 \u0026ndash; Human Epidermal growth factor 2, IDC \u0026ndash; Invasive Ductal carcinoma\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCase 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCase 3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScreening (BI-RADS IV)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePalpable lump\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eScreening (BI-RADS IV)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumour Location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeft upper outer quadrant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRight lower quadrant (6\u0026ndash;7 o\u0026rsquo;clock)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRight upper quadrant (12 o\u0026rsquo;clock)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInvasive tubular carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIDC, Grade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIDC, Grade III\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eER / PR / HER2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eER+/PR+, HER2\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eER+, PR\u0026ndash;, HER2 FISH\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTriple negative\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKi-67 (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u0026ndash;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumour Size (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6 \u0026times; 0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5 \u0026times; 1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9 \u0026times; 1.1 \u0026times; 1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDCIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymph Node Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0/1 (SLNB)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0/15 (SLNB\u0026thinsp;+\u0026thinsp;clearance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/1 (SLNB)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological Stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epT1bN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003epT1cN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003epT1cN0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdjuvant Therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCT\u0026thinsp;+\u0026thinsp;Hormonal\u0026thinsp;+\u0026thinsp;RT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCT\u0026thinsp;+\u0026thinsp;RT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-Up Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWell\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWell\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCT \u0026ndash; Chemotherapy, RT \u0026ndash; Radiotherapy, ER \u0026ndash; Estrogen Receptor, PR- Progesterone Receptor, Her 2 \u0026ndash; Human Epidermal growth factor 2, IDC \u0026ndash; Invasive Ductal carcinoma\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis 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.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEBCS 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConsent: All patients provided informed consent for surgery and publication of anonymized data/images.\u003c/p\u003e\n\u003cp\u003eFunding: This research received no external funding.\u003c/p\u003e\n\u003cp\u003eConflict of interest: The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eAuthor contributions: [D. Pon Jeeva Mathan] conceived the study; [D. Pon Jeeva Mathan] performed surgeries; [D. Pon Jeeva Mathan] collected and analyzed data; [D. Pon Jeeva Mathan] drafted the manuscript; all authors reviewed and approved the final version.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors thank the surgical team and nursing staff for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi L, Liang Y, Li C, et al. Comparison of endoscopic breast-conserving surgery versus conventional breast-conserving surgery for early-stage breast cancer: a meta-analysis. Front Oncol. 2024;14:1419123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2024.1419123\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2024.1419123\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang ZH, Gang TR, Wu SS, et al. 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Endoscopy-assisted breast-conserving surgery versus conventional breast-conserving surgery for breast cancer: a meta-analysis. Breast J. 2020;26(6):1234\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tbj.13959\u003c/span\u003e\u003cspan address=\"10.1111/tbj.13959\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamagata Y, Shindo M, Sugitani I, et al. Cosmetic outcomes and patient satisfaction after endoscopic-assisted breast-conserving surgery. Breast Cancer. 2019;26(2):212\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12282-018-0893-2\u003c/span\u003e\u003cspan address=\"10.1007/s12282-018-0893-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMathan PJ, Gandhirajan K, Bose JC. Endoscopic breast conservation surgery for early-stage invasive carcinoma: a case report-first case from India. Int Surg J. 2025;12(8):1372\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18203/2349-2902.isj20252293\u003c/span\u003e\u003cspan address=\"10.18203/2349-2902.isj20252293\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"endoscopic breast surgery, breast-conserving surgery, sentinel lymph node biopsy, minimally invasive, cosmesis, India","lastPublishedDoi":"10.21203/rs.3.rs-7565823/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7565823/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEndoscopic 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eBetween 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll 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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEBCS 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.\u003c/p\u003e","manuscriptTitle":"Endoscopic Breast-Conserving Surgery with Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer: Initial Indian Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 09:15:48","doi":"10.21203/rs.3.rs-7565823/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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