Prospective evaluation of the limitations of near-infrared imaging in detecting axillary sentinel lymph nodes in primary breast cancer

Abstract

We compared the performance of near-infrared imaging using indocyanine green (ICG) with the radioisotope (ISO) method to detect sentinel lymph nodes (SLNs) in breast cancer, to analyze predictive factors for negative ICG identification. The study included 122 patients who underwent sentinel lymph node biopsy (SLNB) using the combined ISO and ICG technique for primary breast cancer. We assessed the putative association between pathologic/clinical variables and ICG failure to detect SLNs. The ISO identification rate was 96.7% and ICG identification 81.9%.Overweight patients or presence of macrometastasis in SLNB were associated with the risk of ICG failing to detect SLNs (P = 0.02). K E Y W O R D Sbreast cancer, indocyanine green, sentinel lymph node, technetium, false negative

Indocyanine green for sentinel lymph node detection in early breast cancer: Prospective evaluation of detection rate and toxicity—The FLUOBREAST trial

“…This association provides a better outcome for sentinel lymph node detection in our series than in other French studies. 22 Our results are concordant with literature. In the two largest published series of 301 and 847 patients, authors found a detection rate of 99% and 97%, respectively, a high concordance rate and a better sensitivity of indocyanine green for positive sentinel lymph node than radioisotopes alone.…”

“…Infracyanine ® is a specialty of indocyanine green that does not contain iodine and thus reduces the risk of allergy. This association provides a better outcome for sentinel lymph node detection in our series than in other French studies 22 …”

“…Median time between indocyanine green injection and incision of the axilla was around the 12 minutes range 2‐27 . Median time between incision and removal of the last sentinel lymph node was 14 minutes, range [4‐50].…”

“…However, in France, the use of indocyanine green in intratissular injection is not allowed by the health authorities. Some authors have shown controversial results of the indocyanine green method and very few surgeons use it despite its obvious interest 21,22 . Our clinical trial was designed to evaluate the detection rate of indocyanine green and the concordance rate between indocyanine green and isotopes for the detection of sentinel lymph node in early breast cancer.…”

Reply–To Letter to the Editor; Prospective evaluation of the limitations of near‐infrared imaging in detecting axillary sentinel lymph nodes in primary breast cancer

“…Zeng et al analyzed 40 clinical studies mainly from Asia since 2010 and reported an average ICG SLN detection rate of 95% but with a higher number of lymph nodes resected (from 1.75 to 3.8). As observed in our experience, a lower detection rate for ICGSLN was observed in overweight and obese patients . In contrast to Cattin et al experience, we did not adopt for this first prospective study, a variation in the amount of ICG injected.…”