Randomized comparison between indocyanine green fluorescence plus 99mtechnetium and 99mtechnetium alone methods for sentinel lymph node biopsy in breast cancer

Abstract

Use of both patent blue and a radioisotope to locate, and reduce the risk of sentinel lymph node (SLN) detection failure in breast cancer is recommended, but drawbacks commonly lead to using only a radioisotope. An alternative method would therefore be valuable. This randomized, controlled study in 99 patients compared SLN detection using 99m technetium (Tc) alone versus Tc combined with indocyanine green (ICG). The primary endpoint was the SLN identification rate. The primary outcome measure was the number of patients with <2 SLN detected. One SLN was detected in 44.0% of patients in the dual detection group and 40.8% in the 99m Tc alone group (RR = 1.08 (95% CI 0.68; 1.72), p = 0.84). A mean (±SD) of 2.14 ± 1.23 SLN were identified in the dual detection group vs . 1.77 ± 0.85 using Tc alone ( p = 0.09). Eight-five (78.7%) SLN were both ICG+ and TC+, 15 (13.9%) ICG+ and Tc−, and 7 (6.5%) ICG− and Tc+. SLN detected were ICG-positive in 92.6% of patients and 99m Tc-positive in 85.2% with. No adverse event related to ICG injection was recorded. Dual detection of SLN using ICG and radioisotope is reliable and sensitive but was not superior to isotope alone in successfully locating SLN in our pilot randomized trial.

Indocyanine Green Fluorescence Versus Blue Dye or Radioisotope Regarding Detection Rate of Sentinel Lymph Node Biopsy and Nodes Removed in Breast Cancer: A Systematic Review and Meta-Analysis

“…The detection rate was reportedly enhanced when the combination was used (Guo et al, 2017;Vermersch et al, 2019). In aforementioned study, it was found that SLN detection rates with ICG, BD, and their combination were 97%, 89%, and 99.5%, respectively (p<0.001).…”

A Prospective Self-Controlled Study of Indocyanine Green, Radioisotope, and Methylene Blue for Combined Imaging of Axillary Sentinel Lymph Nodes in Breast Cancer

“…In a survey conducted in China, among 110 hospitals performing >200 breast cancer surgeries per year, the majority (69/110, 62.73%) used dye (mainly MB) as the tracer for SLNB; the dual tracer of RI+MB was used only in 16/110 (14.55%) hospitals, probably because of the limited availability of RI tracers (20). Several authors have found ICG to be an excellent tracer in terms of safety, feasibility, and accuracy (21)(22)(23)(24)(25)(26). The feasibility of replacing RI with ICG for axillary SLN tracing in breast cancer is currently a hot topic of research.…”

Sentinel Lymph Nodes Detection in Early-Stage Breast Cancer: ICG-Enhanced Fluorescence and Radioactivity Detection Methods Comparison

“…In our case, this indicator was 2.4 for 99m Tc and 3.3 for ICG (1.39 times higher). The advantage of ICG over 99m Tc was also shown during the recent randomized study performed in France, where the average number of biopsies in the group with 99m Tc composed 1.77, and 2.14 (1.2 times higher) with double detection (ICG + 99m Tc) [17]. Comparison with a wider range of data that we performed on the basis of reviews and (21 studies, from 2009 to 2015), supplemented by current data, showed 99m Tc 1.35-2.3 (1.8), blue 1-2.4 (1.8), ICG 1.75-5.4 (2.7), 99m Tc + blue 1.5-2.4 (1.9), ( 99m Tc + ICC) 1.5-2.4 (1.9) (in brackets -the mean value for all published studies) [2,3].…”