Sentinel-Lymphnode Biopsy in primary breast cancer: 99mTc versus ICG—A prospective, randomized trial.

Abstract

575 Background: Sentinel-Lymphnode Biopsy (SLNB) is the standard procedure in primary breast cancer, routinely performed with 99mTechnetium radioactive tracers. Awareness of nuclear waste, costs and time consumption lead to the desire of breast surgeons to find safe and effective alternative options for detection of sentinel lymph nodes (SLN) in breast cancer and melanoma. Indocyaningreen is a tracer which emits fluorescence with near-infrared light of 780-810 nm when injected in the peritumoral or periareolar region, enabling surgeons to detect SLN and lymphatic pathways at the breast. Methods: We performed a prospective, randomized trial with patients with primary breast cancer. Both detection methods have been applied to patients of the study cohort comparing the preparation time, time to identify, concordance of the two methods and costs. Reference method was preoperative lymphszintigraphy. Results: 55 patients have been analyzed in this first report. Preparation time was 75,8 min (range 60-120 min) for 99mTc-tracer and a standard of 20 min for ICG. Time to identify SLN at a mean of 3,8 min(range 1-15 min) for 99mTc and 3 min (range 1-8 min) for ICG. Concordance rates were 98,2 % for the 1st SLN, 93,8 % both for 2nd and 3rd SLN. After neoadjuvant chemotherapy, all SLN have been been detected by both techniques, in 3 patients additional SLN have been found by ICG. Costs have been cut down to 1/10 with the use of ICG, coming up to saving of 27 000 US-$ per each 100 SLNB procedures performed. Conclusions: We report a high concordance rate between the 2 techniques - 99mTechnetium and ICG with near-infrared - for detection of SLN in breast cancer. Preparation time is cut down to less than 30 %, and costs to less the 10 % of radioactive labelling. Clinical trial information: 18-8054-BO .