Abstract
PurposeThis self-controlled study aimed to clarify whether indocyanine green (ICG) could be an alternative tracer in the absence of radioisotope (RI) for combined imaging of axillary sentinel lymph node (SLN) in breast cancer.MethodsPrimary breast cancer, clinically axillary node-negative patients (n = 182) were prospectively enrolled from March 2015 to November 2020. ICG, methylene blue (MB), and RI were used to perform axillary sentinel lymph node biopsy (SLNB). The main observation index was the positivity of ICG + MB vs. RI + MB in axillary SLNB; the secondary observation indicators were the axillary SLN detection rate, mean number of axillary SLNs detected, mean number of metastatic axillary SLNs detected, and safety.ResultsAll 182 patients had axillary SLNs; a total of 925 axillary SLNs were detected. Pathological examination confirmed metastatic axillary SLN in 42 patients (total of 79 metastatic SLNs). Positivity, detection rate of SLNs, detection rate of metastatic SLNs, and the number of metastatic SLNs detected were comparable with RI+MB and ICG+MB (p > 0.05). The mean number of axillary SLNs detected was significantly higher with ICG+MB than with RI+MB (4.99 ± 2.42 vs. 4.02 ± 2.33, p < 0.001). No tracer-related adverse events occurred.ConclusionsICG appears to be a safe and effective axillary SLN tracer, and a feasible alternative to RI in combined imaging for axillary SLN of breast cancer.
Highlights
Sentinel lymph node biopsy (SLNB) for breast cancer is a minimally invasive technique that can provide accurate axillary staging [1, 2]
Neoadjuvant chemotherapy was administered to 30 (16.5%) patients. 42 patients (24.2%) had metastatic axillary sentinel lymph node (SLN), axillary lymph node dissection (ALND) was performed for 35 (19.2%) patients, and 7 patients with metastatic axillary SLNs who underwent breast conserving surgery did not receive ALND according to the results of the Z0011 study [19]
The results showed that the positivity and SLN detection rates of indocyanine green (ICG)+methylene blue (MB) and RI+MB were equal (100%) in 30 patients after neoadjuvant chemotherapy
Summary
Sentinel lymph node biopsy (SLNB) for breast cancer is a minimally invasive technique that can provide accurate axillary staging [1, 2]. When SLNB is negative, axillary lymph node dissection (ALND) [1, 3, 4] can be avoided, and the patient is spared the suffering caused by complications such as upper limb lymph edema, nerve damage, local pain, numbness, and shoulder stiffness [1]. A key factor for the accuracy of axillary SLNB is the tracer that is used [5]. The American Society of Clinical Oncology (ASCO) recommends the dual tracer method for axillary SLNB because of its high detection rate (>90%), low false-negative rate (5%–10%), and the short learning curve [6]. The RI method cannot provide clear and intuitive visual guidance during the surgery and may impair the surgeon’s ability to locate the sentinel lymph node. There is much ongoing research to identify lymphatic tracers that could replace RI
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