A comparison of indocyanine green fluorescence imaging plus blue dye and blue dye alone for sentinel node navigation surgery in breast cancer patients.
OBJECTIVE
To evaluate two methods of sentinel node navigation surgery (SNNS) using blue dye with and without indocyanine green (ICG) fluorescence imaging (FI) to determine the usefulness of combined ICG and blue dye.


METHODS
Between 2005 and 2010, a total of 501 patients underwent SNNS in our hospital. Detection of sentinel lymph node (SLN) was performed with sulfan blue (SB) alone until 2008 and with a combination of SB and ICG-FI since 2009. ICG 5 mg and SB 15 mg were injected in the subareolar region, and FI was obtained by a fluorescence imaging device.


RESULTS
We attempted to identify SLNs in 393 patients by SB alone and in 108 patients by a combination of SB and FI. The mean number of SLNs detected was 1.6 (0-5) for SB alone and 2.2 (1-6) for the combination method. The SLN identification rate was 95.7 % for SB alone and 100 % for the combination method so that the combination was significantly superior to SB in terms of the identification rate (p = 0.0037). In patients who received the combination method, detection of SLN was made through only SB in 1 patient, only ICG in 8 patients, and both in 99 patients. Lymph node metastasis was found in 56 patients with SB alone and in 16 patients with the combination method. Recurrence of an axillary node was observed in 3 patients (0.8 %) with SB alone and in no patients with the combination method.


CONCLUSIONS
ICG-FI is a useful method and is especially recommended in cases where no radiotracers are available.
Department of Breast Surgery, Tokyo Women's Medical University Medical Center East, Nishiogu 2-1-10, Arakawa-ku, Tokyo 116-8567, Japan. ahirasu@dnh.twmu.ac.jp
Akira
A
Hirano
Mari
M
Kamimura
Kaoru
K
Ogura
Naomi
N
Kim
Akinori
A
Hattori
Yumika
Y
Setoguchi
Fumie
F
Okubo
Hiroaki
H
Inoue
Reiko
R
Miyamoto
Jun
J
Kinoshita
Mariko
M
Fujibayashi
Tadao
T
Shimizu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007208:Indocyanine Green; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C008769:sulfan blue; D007208:Indocyanine Green