title: Breast cancer sentinel lymph node mapping using near infrared guided indocyanine green and indocyanine green--human serum albumin in comparison with gamma emitting radioactive colloid tracer.
abstract: OBJECTIVE
  Recently, a novel method of using near infrared (NIR) guided indocyanine green (ICG) and ICG conjugated with human serum albumin (ICG:HSA) for sentinel lymph node biopsy (SLNB) of breast cancer patients has shown true potential. The aim of this study was to compare the usefulness of NIR guided ICG and ICG:HSA against the gamma emitting radiocolloid (RC).
  
  
  METHODS
  A group of 49 consecutive breast cancer patients underwent SLNB using RC. From this group, the first 28 patients were compared against ICG, while the next 21 patients were compared against ICG:HSA. The number of patients with visible fluorescent path was recorded. Furthermore, the number of SLNs detected by fluorophores percutaneously and total number of intraoperative SLNs detected by fluorophores and/or RC was noted.
  
  
  RESULTS
  NIR guided real time lymphatic flow was observed in 47/49 patients (96%). In all cases except one, SLNs detected by the RC tracer were also detected by their respective fluorophore. Additionally, ICG detected 10 additional SLNs in 8 patients, while 3 additional SLNs were detected by ICG:HSA in 3 patients. Statistical analysis revealed no difference between the number of SLNs detected between ICG versus ICG:HSA and RC versus ICG:HSA. However, a significant statistical difference was observed between RC and ICG (p=0.0117), as well as between the combined NIR guided and RC method (p=0.0033).
  
  
  CONCLUSIONS
  In conclusion, the use of either ICG or ICG:HSA with RC to obtain SLNB seems to be an effective alternative. Compared to RC alone, the use of ICG:HSA, more so than ICG alone, may provide additional benefits.
authors: 1st Surgical Oncology and General Surgery Department, Greater Poland Cancer Center, 15 Garbary Street, 61-866 Poznan, Poland. POLOM.KAROL@gmail.com
authors: K
authors: K
authors: Polom
authors: D
authors: D
authors: Murawa
authors: P
authors: P
authors: Nowaczyk
authors: Y S
authors: YS
authors: Rho
authors: P
authors: P
authors: Murawa
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007208:Indocyanine Green; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D018709:Statistics, Nonparametric
chemical_list: D000418:Albumins; D004396:Coloring Agents; D019275:Radiopharmaceuticals; D007208:Indocyanine Green