title: Transcutaneous detection and direct approach to the sentinel node using axillary compression technique in ICG fluorescence-navigated sentinel node biopsy for breast cancer.
abstract: BACKGROUND
  Indocyanine green (ICG) fluorescence navigation is a useful option in sentinel node biopsy (SNB) for breast cancer. However, several technical difficulties still exist. Since the sentinel node (SN) cannot be recognized over the skin, subcutaneous lymphatic vessels (LVs) must be carefully dissected without injury. In addition, the dissecting procedures are often interrupted by turning off the operating light during fluorescence observation. In this report, we introduce a new approach using the axillary compression technique to overcome these problems.
  
  
  METHODS
  In the original procedure of the ICG fluorescence method, the subcutaneous lymphatic drainage pathway from the breast to the axilla was observed in fluorescence images, but no signal could be obtained in the axilla. When the axillary skin was compressed against the chest wall using a plastic device, the signals from the deeper lymphatic structures could be observed. By tracing the compression-inducible fluorescence signal towards the axilla, transcutaneous detection and direct approach to the SN were achieved. The benefit of this approach is that there is no risk of injury of LVs, and the procedures are interrupted less frequently by fluorescence observation. The axillary compression technique was used in 50 patients with early breast cancer.
  
  
  RESULTS
  SNs were successfully removed in all patients. Transcutaneous detection and direct approach were possible in 47 patients. This approach was also effective in obese patients.
  
  
  CONCLUSIONS
  Axillary compression technique is a simple way to facilitate the surgical procedures of ICG fluorescence-navigated SNB for breast cancer.
authors: Department of Surgery, Nara Social Insurance Hospital, Yamatokoriyama, Japan. kitait@kuhp.kyoto-u.ac.jp
authors: Toshiyuki
authors: T
authors: Kitai
authors: Masahiro
authors: M
authors: Kawashima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D042601:Lymphatic Vessels; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green