title: Axillary lymph node recurrence after sentinel lymph node biopsy performed using a combination of indocyanine green fluorescence and the blue dye method in early breast cancer.
abstract: BACKGROUND
  There is limited information on indocyanine green (ICG) fluorescence and blue dye for detecting sentinel lymph node (SLN) in early breast cancer. A retrospective study was conducted to assess the feasibility of an SLN biopsy using the combination of ICG fluorescence and the blue dye method.
  
  
  METHODS
  Seven hundred and fourteen patients with clinically node-negative breast cancer were included in this study. They underwent SLN biopsy using a combination of ICG fluorescence and the blue dye method from March 2007 to February 2014. The ICG (a fluorescence-emitting source) and patent blue (the blue dye) were injected into the patients' subareolar region. The removed lymph nodes that had ICG fluorescence and/or blue dye uptake were defined as SLNs. The results of the SLN biopsies and follow-up results of patients who underwent SLN biopsy alone were investigated.
  
  
  RESULTS
  In 711 out of 714 patients, SLNs were identified by a combination of ICG fluorescence and the blue dye method (detection rate, 99.6 %). The average number of SLNs was 2.4 (range 1-7), and the average number of resected swollen para-SLNs was 0.4 (range 0-5). Ninety-nine patients with an SLN and/or para-SLN involvement during the intraoperative pathological diagnosis underwent axillary lymph node resection (ALND). In addition, two of three patients whose SLN was not identified also underwent ALND. In 46 of 101 patients with an ALND, non-SLN involvement was not found. Follow-up results were analyzed in 464 patients with invasive carcinoma excluding those with ductal carcinoma in situ (n = 148) and those who underwent ALND (n = 101). During the follow-up period (range 4.4-87.7 months; median, 38 months), two patients (0.4 %) developed axillary lymph node recurrence. They were successfully salvaged, and to date, no further locoregional recurrence has been observed.
  
  
  CONCLUSIONS
  A high rate of SLN detection and low rate of axillary lymph node recurrence were confirmed by an SLN biopsy using a combination of ICG fluorescence and the blue dye method. Therefore, it is suggested that this method may replace the combination of dye and radioisotope methods.
authors.affiliation: Department of Breast Surgery, Kaizuka City Hospital, 3-10-20, Hori, Kaizuka, Osaka, 597-0015, Japan. inoue@watanabe-hp.or.jp.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Breast Surgery, Kaizuka City Hospital, 3-10-20, Hori, Kaizuka, Osaka, 597-0015, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Department of Breast Surgery, Kaizuka City Hospital, 3-10-20, Hori, Kaizuka, Osaka, 597-0015, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Breast Surgery, Kaizuka City Hospital, 3-10-20, Hori, Kaizuka, Osaka, 597-0015, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Nishimae
authors.affiliation: Department of Diagnostic Radiology, Kaizuka City Hospital, Kaizuka, Osaka, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sawai
authors.affiliation: Department of Pathology, Kaizuka City Hospital, Kaizuka, Osaka, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Department of Breast Surgery, Kaizuka City Hospital, 3-10-20, Hori, Kaizuka, Osaka, 597-0015, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Inaji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007124:Immunoenzyme Techniques; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy
chemical_list: D014408:Biomarkers, Tumor; D004396:Coloring Agents; D007208:Indocyanine Green; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D012394:Rosaniline Dyes; C508053:ERBB2 protein, human; C008769:sulfan blue
keywords: Breast cancer; Fluorescence; Indocyanine green; Patent blue; Sentinel lymph node biopsy