Abstract
Simple SummaryThis randomized study was conducted to evaluate sentinel lymph node biopsy with indocyanine green (ICG) compared with blue dye as a tracer in women with early breast cancer without any sign of lymph node invasion. ICG is a fluorescent tracer well known in medical practice for 50 years that is used as tracer of sentinel lymph nodes in numerous types of cancers other than breast cancer. This tracer is cheaper than radioactive tracers, with an easy learning curve.Background: Indocyanine green (ICG) is a promising tracer for sentinel lymph node biopsy in early breast cancer. This randomized study was conducted to evaluate sentinel lymph node biopsy with ICG compared with blue dye as a tracer in woman with early breast cancer without any sign of lymph node invasion. Methods: Between January 2019 and November 2020, 240 consecutive women with early breast cancer were enrolled and randomized to sentinel lymph node biopsy using ICG or blue dye. The primary endpoint was the sentinel lymph node detection rate in both arms. Results: ICG was used in 121 patients and detected sentinel lymph nodes in all patients (detection rate, 100%; 95% CI: 96.9–100.0) while blue dye was used in 119 patients and detected sentinel lymph nodes in 116 patients (detection rate: 97.5%, 95% CI: 92.9–99.1). This analysis indicated the non-inferiority of ICG vs. blue dye tracer (90%CI: −1.9–6.9; p = 0.0009). Conclusion: ICG represents a new promising tracer to detect sentinel lymph nodes in early breast cancer with a detection rate similar to other conventional tracers, and is associated with easy learning and low cost. Our result suggest that this technique is a good alternative to avoid radioactive isotope manipulation.
Highlights
Since the 20th century, a less invasive method, the sentinel lymph node biopsy (SLNB) technique has been developed to decrease shoulder and arm morbidity [1] and has replaced the axillary lymph node dissection as the standard surgical approach to early breast cancers without pre-operative evidence of nodal infiltration [2,3].The SLNB technique most frequently used worldwide is based on the radioisotope 99 m technetium either alone or in combination with blue dye
More than 70% of breast cancers presented an invasive ductal histology (77% in blue dye and 73% in Indocyanine green (ICG)), while 6% of both groups presented an in situ component
Conservative surgery was performed in 80% and 77% of patients in the blue dye and ICG cohorts, respectively
Summary
Since the 20th century, a less invasive method, the sentinel lymph node biopsy (SLNB) technique has been developed to decrease shoulder and arm morbidity [1] and has replaced the axillary lymph node dissection as the standard surgical approach to early breast cancers without pre-operative evidence of nodal infiltration [2,3].The SLNB technique most frequently used worldwide is based on the radioisotope 99 m technetium either alone or in combination with blue dye. Indocyanine green (ICG) is a promising tracer for sentinel lymph node biopsy in early breast cancer. Methods: Between January 2019 and November 2020, 240 consecutive women with early breast cancer were enrolled and randomized to sentinel lymph node biopsy using ICG or blue dye. Results: ICG was used in 121 patients and detected sentinel lymph nodes in all patients (detection rate, 100%; 95% CI: 96.9–100.0) while blue dye was used in 119 patients and detected sentinel lymph nodes in 116 patients (detection rate: 97.5%, 95% CI: 92.9–99.1). Conclusion: ICG represents a new promising tracer to detect sentinel lymph nodes in early breast cancer with a detection rate similar to other conventional tracers, and is associated with easy learning and low cost. Our result suggest that this technique is a good alternative to avoid radioactive isotope manipulation
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