An intraoperative sentinel lymph node identification in breast cancer patients guided by near-infrared fluorescence imaging: Preliminary results

Abstract

10776 Background: Recently, radioactive tracer, a vital dye, or a combination of both has been applied to detect intraoperative sentinel lymph nodes (SLN) in early breast cancers. In this study, we present a novel method in SLN identification that provides with high detection and low false-negative rates. Methods: This study enrolled 19 patients with a tumor less than 3 cm in diameter. Their mean age was 49.6 years. Preoperative TNM stage was I in 13 cases, IIa in 4, and IIb in 2, respectively. Initially the combination dye of indocyanine green and indigocarmine was injected subdermally in the areolar. Fluorescence imaging (photodynamic eye: Hamamatsu Photonics Co.) was obtained using a charge coupled device camera with a cut filter as the detector, and light emitting diodes at 760 nm as the light source. Subcutaneous lymphatic channels draining from the areola to the axilla or other directions were visible by fluorescence imagings immediately. After incising the axillary skin on the disappeared point of fluorescence image, SLN was then dissected under the guidance of fluorescence. Results: In all patient, lymphatic channels and SLN were successfully visualized. SLN was observed before skin incision in two patients. The number of fluorescence SLN ranged from 2 to 11 (mean: 5.5) and blue dyed SLN ranged from o to 6 (mean: 2.3). In the latter, SLN was not identified in one patient. Six patients had lymph node metastases pathologically. All of them were recognized by fluorescence imagings, however, in two patients LN with metastasis were not identified by a vital dye. There were no intra- or postoperative complications associated with SLN identification. Conclusions: This method is feasible and safe to detect SLN intraoperatively with less invasive, real-time observation and no requirement of training. We hope that this method will provide with high detection and low false-negative rates in SLN navigation surgery. No significant financial relationships to disclose.