Indocyanine Green (ICG) Fluorescence Imaging in Sentinel Lymph Node Biopsy (SLNB) for Early Breast Cancer: First Indian Experience

Abstract

To explore the utility and safety of indocyanine green (ICG) for the fluorescence-guided detection of sentinel lymph nodes (SLNs) during sentinel lymph node biopsy (SLNB) in patients with early breast cancer. Patients diagnosed with early breast cancer with clinically negative axilla were involved in the study. ICG dye was injected as per protocol. Sentinel lymph node (SLN) was harvested and axillary clearance was done in all patients irrespective of SLN status. SLN identification rate, sensitivity, specificity, positive predictive value, negative predictive value and false negative rate were calculated. Forty patients were involved in the study, with most of the patients being in their fifth decade. Median BMI of patient was 24 (range 19–34). SLN was identified in all the patients, total of 110 nodes were detected, with mean being 2.75 (1–6). Seventeen of 40 patients had positive nodes on axilla, of which 16 were detected by SLN and one patient had isolated tumour cells which were detected on final grossing and histopathology report. The sensitivity, specificity, positive predictive value, negative predictive value and false negative rate were 94.1%, 100%, 100%, 95.8% and 5.8%, respectively. None of the patients had any complications with ICG injection. ICG-based fluorescence technique is easy and safe for SLNB in early breast cancer and is ready for clinical application. A well-designed study comparing the standard dual dye technique with ICG needs to be done to explore if it can replace the existing standard.