Breast cancer staging: Sentinel node biopsy using a fluorescence navigation versus standard technique.

Abstract

e12018 Background: Sentinel lymph node (SLN) biopsy with radioisotope has been used successfully for axillary staging in breast cancer. This study evaluated the feasibility of fluorescence detection of SLNs with indocyanine green (ICG) for lymphatic mapping and SLN biopsy. Study evaluated a fluorescence-guided technique for sentinel node biopsy (SLNB) against the standard (radioisotope). This technique requires two devices: A fluorescence tracer – ICG and the hand held near infrared camera. The standard technique for SLNB has drawbacks, including exposure to radiation, legislation on use of radiation and poor preoperative imaging. Therefore fluorescence guided with its advantages may by an alternative method for SLN visualization. Methods: Patients with T1 and T2 primary breast cancer treated between Sept. 2012 - Jan. 2013 without clinical and radiological lymph node involvement were included into this study. Standard SLN technique using blue dye and radioisotope was used. Additionally ICG as a fluorescence-emitting source was injected into the tumor area prior to the surgery. Sentinel node biopsy was undertaken using NIR camera initially and than with gammaprobe. The proportion of sentinel nodes detected (sentinel node identification rate) with either the standard or the fluorescence techniques was calculated. Results: Twenty-one SLNB procedures were undertaken in 20 patients. The proportion of successful identification rate with the ICG was 69%, whereas with standard technique 73%. One procedure was unsuccessful with standard technique and patient was found to have no metastases to SLN. Three patients who were unsuccessful with ICG had lymph node involvement. Of 32 lymph nodes removed 29 were true sentinel nodes identified by the radioisotope. Lymph node retrieval rate was 1.38 nodes per patient overall, 1.4 nodes per patient with the standard technique and 1.3 nodes per patient with the fluorescence-guided technique Conclusions: Moderate rate of SLN detection was achieved using both the ICG and radioisotope. The first SLN identified by fluorescence imaging provided an exact indication of the axillary status. Therefore, the ICG method provided sufficient information required to avoid unnecessary ALND.