Abstract
We investigated the feasibility of sentinel lymph node (SLN) biopsy using indocyanine green (ICG) technique in 411 patients with early breast cancer at three institutes. ICG, a fluorescence source, and blue dye were injected into the subareolar area to enable real-time image-guided surgery and identification of SLN fluorescence after meticulous dissection. The subcutaneous lymphatic channels were precisely detected in all cases. SLN identification rate was 99% (408/411) with a mean of 2.3 nodes identified per patient. Thirty-nine cases (9.5%) had SLNs involved and all of them were ICG positive. Thus, the ICG technique has a high SLN identification rate comparable with that of the radioisotope method.
Highlights
Sentinel lymph node (SLN) biopsy is a standard method for evaluating axillary lymph node status in early breast cancer
A novel method using an indocyanine green (ICG) fluorescence imaging system has recently been published with reported SLN identification rates of 94–100% [3,4]
Informed consent was obtained from the patients for lymphatic mapping and SLN biopsy using ICG and a blue dye as a prelude to SLNB
Summary
Sentinel lymph node (SLN) biopsy is a standard method for evaluating axillary lymph node status in early breast cancer. SLNs are the first point to harbor metastasis in the axilla They are representative of the actual lymph node status and provide information on the necessity for further management after axillary surgery. A novel method using an indocyanine green (ICG) fluorescence imaging system has recently been published with reported SLN identification rates of 94–100% [3,4]. In this system, lymphatic flows were traced with a charge-coupled device (CCD), and real-time image guided surgery enabled identification of the correct site for exploring SLNs. Fluorescent lymph nodes were harvested as SLNs, and this technique provided a success rate comparable to that of the radioisotope method in preliminary studies. We detail the results of our ICG fluorescence navigation technique for SLN biopsy in 411 consecutive patients with breast cancer
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