title: Comparison of the indocyanine green fluorescence and blue dye methods in detection of sentinel lymph nodes in early-stage breast cancer.
abstract: OBJECTIVE
  To assess the diagnostic performance of sentinel lymph node (SLN) biopsy using the indocyanine green (ICG) fluorescence method compared with that using the blue dye method, a prospective multicenter study was performed.
  
  
  METHODS
  Patients with T1-3 primary breast cancer without clinical lymph node involvement were included in this study. ICG as a fluorescence-emitting source and indigo carmine as blue dye were injected into the subareolar area. Extracted lymph nodes were examined to identify the first, second, and other SLNs. The identified nodes were classified according to the ICG fluorescence signal and blue dye uptake.
  
  
  RESULTS
  Ninety-nine eligible patients were included in this study. The ICG fluorescence method identified an average of 3.4 SLNs (range, 1-8) in 98 of 99 patients (detection rate, 99 %). The number of lymph nodes identified by the fluorescence method was significantly higher than that identified by the blue dye method (p < 0.001). SLN involvement was identified in 20 % (20 of 99) of patients, all of whom tested positive for the first SLN. In 16 patients, complete axillary lymph node dissection (ALND) was performed. In 25 % (4 of 16) of these patients, axillary metastases were identified; however, no axillary involvement was found in 8 patients with only one involved node, which was isolated as the first SLN.
  
  
  CONCLUSIONS
  High rate of SLN detection was achieved using the ICG fluorescence method. The first SLN identified by fluorescence imaging provides an exact indication of the axillary status. Therefore, the ICG fluorescence method provides precise information required to avoid unnecessary ALND.
authors: Department of Breast Surgery, Kyoto University, Kyoto, Japan. sugie@kuhp.kyoto-u.ac.jp
authors: Tomoharu
authors: T
authors: Sugie
authors: Terumasa
authors: T
authors: Sawada
authors: Nobumi
authors: N
authors: Tagaya
authors: Takayuki
authors: T
authors: Kinoshita
authors: Kazuhiko
authors: K
authors: Yamagami
authors: Hirofumi
authors: H
authors: Suwa
authors: Takafumi
authors: T
authors: Ikeda
authors: Kenichi
authors: K
authors: Yoshimura
authors: Miyuki
authors: M
authors: Niimi
authors: Akira
authors: A
authors: Shimizu
authors: Masakazu
authors: M
authors: Toi
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007203:Indigo Carmine; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine; D007208:Indocyanine Green