Intraoperative identification of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer.
We present a novel method for sentinel lymph node (SLN) identification by fluorescence imaging that provides a high detection rate and a low false-negativity rate. Twenty-five breast cancer patients with tumors less than 3 cm in diameter were enrolled. A combination of indocyanine green and indigo carmine was injected subdermally in the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were immediately showed by fluorescence imaging. After incising the axillary skin near the point of disappearance of the fluorescence, the SLN was dissected under fluorescence guidance. In all patients, the lymphatic channels and SLN were successfully visualized. The mean number of fluorescent SLN and blue-dyed SLN were 5.5 and 2.3. Eight patients were found to have lymph node metastases pathologically. All of them were recognized by fluorescence imaging. This method is feasible and safe for intraoperative detection of SLN allowing real-time observation without any need for training.
Tagaya
Nobumi
N
Second Department of Surgery, Dokkyo University School of Medicine, Mibu, Tochigi, Japan. tagaya@dokkyomed.ac.jp
Yamazaki
Rie
R
Nakagawa
Aya
A
Abe
Akihito
A
Hamada
Kiyoshige
K
Kubota
Keiichi
K
Oyama
Tetsunari
T
D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007203:Indigo Carmine; D007208:Indocyanine Green; D007432:Intraoperative Period; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D021701:Sentinel Lymph Node Biopsy; D013050:Spectrometry, Fluorescence; D019265:Spectroscopy, Near-Infrared
D004396:Coloring Agents; D007203:Indigo Carmine; D007208:Indocyanine Green