Sentinel Lymph Node Navigation Surgery with Indocyanine Green Fluorescence in Early Breast Cancer.

Abstract

Abstract Background: Sentinel lymph node (SLN) biopsy is a minimally invasive and effective method for assessing axillary lymph node status in breast cancer. Currently dye techniques, radioisotope techniques or combined techniques are used for SLN detection and recently, near infrared fluorescence imaging has been applied clinically in a breast cancer patient to identify SLN. The concept of this technique is to detect the subcutaneous lymphatic flow from the areola toward the axilla in real time and identify SLN as florescence spot. Our aim in this study is evaluate the feasibility of SLNB by using the ICG technique and the effect of Body Mass Index (BMI) on the number of SLN identify. Methods: The study involved one hundred patients with clinically node negative early breast cancer who were assigned to SLNB, bilateral SLNB were performed on seven of them. A combination of indocyanine green as a fluorescence emitting source and patent blue dyes were injected in the periareolar area and a charge coupled device camera equipped with a cut filter was used, first to trace the subcutaneous lymphatic channels then to identify the florescence image of SLN after meticulous dissection. Both of them were seen in real time on a TV monitor. According to their florescence imaging and the blue color, the LNs were classified as SLN which is either double positive (ICG+/ Dye+) or single positive (ICG+/Dye- or ICG-/ Dye+) and para SLN which is double negative (ICG-/Dye -). Results: The subcutaneous lymphatic channels were detected precisely in all cases. The identification rate of SLN was 100%, (107/107) with a mean number of 3.7 nodes (rang-1 - 12), double positive nodes were found in 83.2% (89/107) with a mean number of 1.5 (range 0-6). The single positive SLNs, i.e. ICG+/ Dye- or ICG-/ Dye+ were found in (87/107) and (4/107) respectively. In twenty six cases (24.3%), the SLNs were involved and all of them were ICG positive. BMI is negatively correlated with number of double positive SLN identified (r= -0.19, P = .02). Conclusion: The ICG and patent blue dye technique gives high sensitivity and provides a comparable result to the dye and radioactive technique. Obesity may reduce the number of double positive SLNs identified. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1017.