P3-07-10: Sentinel Lymph Node Navigation Surgery Using Combination of Indocyanine Green Fluorescence and Blue Dye for Breast Cancer Patients.

Abstract

Abstract Background: Sentinel lymph node (SLN) biopsy is now widely accepted for staging the axilla in breast cancer patients. Several methods are presently used to detect SLNs. Combined use of blue dye and radiocolloid has previously been described as a superior method for detecting SLNs in breast cancer patients, but radiocolloid is not generally available in Japan. SLN detection guided by indocyanine green (ICG) fluorescence could emerge as a new and effective method for SLN biopsy. The aim of this study was to evaluate SLN biopsy using combination of ICG fluorescence and blue dye methods for breast cancer patients. Material and Methods: We enrolled 75 patients with clinically node-negative breast cancer. An isosulfan blue dye solution (5ml) was injected subcutaneously just above the tumor and in the periareolar area after the induction of anesthesia. The injection site was massaged for five minutes and ICG (2ml) was then injected subcutaneously just above the tumor and in the periareolar area before starting the surgical procedure. Subcutaneous lymphatic channels draining from the areola to the axilla were visualized with a fluorescence imaging system (Photodynamic Eye: PDE, Hamamatsu Photonics Corporation, Japan) under fluorescence within several minutes. SLNs were dissected under direct visualization supported by fluorescence and dye navigation and diagnosed by intraoperative frozen section with hematoxylin and eosin staining. Any patient with a positive SLN underwent immediate axillary lymph node dissection (ALND). Results: SLNs were detected in all 75 patients. The fluorescence imaging identified 2.6 SLNs in 74 (98.7%) of 75 patients. The blue dye identified 1.6 SLNs in 68 (90.1%) of 75 patients. Twelve of the 75 (16.0%) patients had metastatic SLNs and ALND was immediately performed. No metastasis revealed in any non-SLN in eight of these 12 patients. Metastatic SLNs were detected by the ICG fluorescence and not by blue dye in four of these 12 patients. Discussion: The combination of ICG fluorescence and blue dye method had two advantages: it could reveal lymph flow on the surface before we determined the skin incision line; and it had a high SLN detection rate. In hospitals where radioisotopes are unavailable, a combination of the two methods would be advantageous. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-10.