Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index

Abstract

Introduction: A recent meta-analysis [1] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI). Materials and Methods: All consecutive patients undergoing sentinel lymph node biopsies (SLNB) for early breast cancer in NHS Tayside were included in a prospective audit of surgical and pathology findings. All patients included in the study received dual injection of patent blue dye and ICG. Approval was obtained from the local Caldicott guardian for collection and use of personal data. Results: Of 239 cases, all were female patients of mean age 62 years (range 27-93). In 4.2% (10/239) of cases neither blue dye nor ICG was present in the axilla. Of the remaining 229 SLNB cases in this series, surgeons documented retrieval of 451 nodes, with a mean surgical nodal count per case of 1.97 (range 1-5) and pathological nodal count of 2.15 (range 0-7). 83 cases were performed in patients with BMI 30-39.9 and 21 cases with BMI>40, with nodal detection rates of 96.4% (80/83) and 95.2% (20/21) respectively in these groups of patients. 20% (48/229) of cases had nodal metastases on histopathology. Conclusions: This is a large single centre study which demonstrates the safety and accuracy of the combined ICG and blue dye technique for SLNB in breast cancer. This is represented by nodal detection rates and node positivity rates which are comparable to previous multicentre studies of standard SLNB regardless of BMI.

Comparison of Sentinel Lymph Node Biopsy by Blue Dye Conjunction With Indocyanine Green or Radioisotope in Early-Stage Breast Cancer: A Prospective Single-Center Observational Study

“…Indocyanine green, a nonallergenic and nonradioactive fluorescent dye, has been proposed as an effective tracer for SLN identification in breast cancer. [10][11][12] It is well known that the SLN detection rates of ICG are superior to those of BD 15 ; however, the efficiency in SLN identification between ICG and RI method is controversial. Stoffels et al 16 found the use of ICG for SLN detection to be inferior compared with RI technique especially in patients in whom the lymph node basin cannot be predicted correctly.…”

“…Indocyanine green, a nonallergenic and nonradioactive fluorescent dye, has been proposed as an effective tracer for SLN identification in breast cancer. 10-12…”

“…Kitai et al 9 first employed a new technique for lymphatic mapping using ICG in breast cancer. Although more studies have supported that the ICG technique is a safe and feasible method for SLN biopsy, 10-12 the comparable results on SLN detection rate between ICG + BD and RI + BD were inconsistent, which need more probe. Therefore, the present study was designed to prospectively assess the concordance between the ICG + BD (ICG-B) method and the 99 mTc-labeled radiotracer RI + BD (RI-B) method to determine the efficacy of ICG to identify the SLN.…”

Application of a self-developed, low-budget indocyanine green camera in surgical imaging – a single institution's experiences

“…In practice, blue dye and isotopic labeling are used for this. In recent years, the use of ICG for the detection of lymphatic vessels and lymph nodes has become widespread [3].…”

New Clinical Application of Indocyanine Green in Fluorescence- Guided Laparoscopic Lymph-node Biopsy in Case of Lymphoma. Preliminary Results on a Case Series

“…Sentinel lymph node biopsy has been validated as a standard of care in breast cancer, melanoma and gynaecological malignancies [1][2][3]. With regards to endometrial and cervical cancer, the use of ICG uorescence imaging has been extensively investigated and has proven to be a safe, time-e cient and reliable method compared to standard tracers such as the Patent blue and technetium 99m [4].…”