title: Lymphatic mapping with fluorescence navigation using indocyanine green and axillary surgery in patients with primary breast cancer.
abstract: The indocyanine green fluorescence (ICGf) navigation method provides real-time lymphatic mapping and sentinel lymph node (SLN) visualization, which enables the removal of SLNs and their associated lymphatic networks. In this study, we investigated the features of the drainage pathways detected with the ICGf navigation system and the order of metastasis in axillary nodes. From April 2008 to February 2010, 145 patients with clinically node-negative breast cancer underwent SLN surgery with ICGf navigation. The video-recorded data from 79 patients were used for lymphatic mapping analysis. We analyzed 145 patients with clinically node-negative breast cancer who underwent SLN surgery with the ICGf navigation system. Fluorescence-positive SLNs were identified in 144 (99%) of 145 patients. Both single and multiple routes to the axilla were identified in 47% of cases using video-recorded lymphatic mapping data. An internal mammary route was detected in 6% of the cases. Skip metastasis to the second or third SLNs was observed in 6 of the 28 node-positive patients. We also examined the strategy of axillary surgery using the ICGf navigation system. We found that, based on the features of nodal involvement, 4-node resection could provide precise information on the nodal status. The ICGf navigation system may provide a different lymphatic mapping result than computed tomography lymphography in clinically node-negative breast cancer patients. Furthermore, it enables the identification of lymph nodes that do not accumulate indocyanine green or dye adjacent to the SLNs in the sequence of drainage. Knowledge of the order of nodal metastasis as revealed by the ICGf system may help to personalize the surgical treatment of axilla in SLN-positive cases, although additional studies are required.
authors.affiliation: Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. megumi817@goo.jp
authors.forename: Megumi
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Sugie
authors.forename: Kassim
authors.initials: K
authors.lastname: Abdelazeem
authors.forename: Hironori
authors.initials: H
authors.lastname: Kato
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Shinkura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takada
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yamashiro
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ueno
authors.forename: Masakazu
authors.initials: M
authors.lastname: Toi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008220:Lymphography / Q000379:methods*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation / Q000379:methods*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green