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A Comparison of Indocyanine Green Fluorescence Imaging Plus Blue Dye and Blue Dye Alone for Sentinel Node Navigation Surgery in Breast Cancer Patients

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

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.

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References

  1. Krag DN, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med. 1988;339:941–6.

    Article  Google Scholar 

  2. Goldhirsch A, Wood WC, Galber RD, et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol. 2007;18:1133–44.

    Article  PubMed  CAS  Google Scholar 

  3. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.

    Article  PubMed  Google Scholar 

  4. Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227:645–53.

    Article  PubMed  CAS  Google Scholar 

  5. Rutgers EJ. Guidelines to assure quality in breast cancer surgery. Eur J Surg Oncol. 2005;31:568–76.

    Article  PubMed  Google Scholar 

  6. Sanidas EE, de Bree E, Tsiftsis DD. How many cases are enough for accreditation in sentinel lymph node biopsy in breast cancer? Am J Surg. 2003;185:202–10.

    Article  PubMed  Google Scholar 

  7. Schwartz GF, Giuliano AE, Veronesi U; Consensus Conference Committee. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19 to 22, 2001, Philadelphia, Pennsylvania. Hum Pathol. 2002;33:579–89.

  8. Sanidas EE, Daskalakis M, Sbyrakis N, et al. Modifications of the learning curve guidelines for breast cancer sentinel node biopsy. Eur J Surg Oncol. 2005;31:357–63.

    Article  PubMed  CAS  Google Scholar 

  9. Kitai T, Inomoto T, Miwa M, Shikayama T. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer. 2005;12:211–5.

    Article  PubMed  Google Scholar 

  10. Tagaya N, Yamazaki R, Nakagawa A, et al. Intraoperative identification of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer. Am J Surg. 2008;195:850–3.

    Article  PubMed  Google Scholar 

  11. McMasters KM, Wong SL, Martin RCG II, et al. Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: results of a multiinstitutional study. Ann Surg. 2001;233:676–87.

    Article  PubMed  CAS  Google Scholar 

  12. Kang SW, Chung SE, Shin WJ, et al. Polypoidal choroidal vasculopathy and late geographic hyperfluorescence on indocyanine green angiography. Br J Ophthalmol. 2009;93:759–64.

    Article  PubMed  CAS  Google Scholar 

  13. Schneider PD. Preoperative assessment of liver function. Surg Clin North Am. 2004;84:355–73.

    Article  PubMed  Google Scholar 

  14. Vogt PR, Bauer EP, Graves K. Novadaq SPY Intraoperative imaging system—current status. Thorac Cardiovasc Surg. 2003;51:49–51.

    Article  PubMed  CAS  Google Scholar 

  15. Hirsche C, Murawa D, Mohr Z, Kneif S, Hunerbein M. ICG fluorescent–guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat. 2010;121:373–8.

    Article  Google Scholar 

  16. Tagaya N, Tsumuraya M, Nakagawa A, et al. 2010 Indocyanine green (ICG) fluorescence imaging versus radioactive colloid for sentinel lymph node identification in patients with breast cancer. J Clin Oncol 28:674.

    Google Scholar 

  17. Aoyama K, Kamio T, Nishizawa M, et al. Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green. World J Surg Oncol. 2011;9:157.

    Article  PubMed  Google Scholar 

  18. Bass SS, Cox CE, Reintgen DS, et al. Learning curves and certification for breast cancer lymphatic mapping. Surg Oncol Clin N Am. 1999;8:497–509.

    PubMed  CAS  Google Scholar 

  19. Dupont E, Cox C, Shivers S, et al. Learning curves and breast cancer lymphatic mapping: Institutional volume index. J Surg Res. 2001;97:92–6.

    Article  PubMed  CAS  Google Scholar 

  20. Hojo T, Nagao T, Kikuyama M, et al. Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer. Breast. 2010;19:210–3.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Breast Surgery, Tokyo Women’s Medical University Medical Center East, Nishiogu 2-1-10, Arakawa-ku, Tokyo, 116-8567, Japan

    Akira Hirano MD, PhD

  2. Department of Breast Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

    Mari Kamimura MD, Kaoru Ogura MD, Naomi Kim MD, Akinori Hattori MD, Yumika Setoguchi MD, Fumie Okubo MD, Hiroaki Inoue MD, Reiko Miyamoto MD, Jun Kinoshita MD, PhD & Tadao Shimizu MD, PhD

  3. Department of Surgical Pathology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

    Mariko Fujibayashi MD, PhD

Authors
  1. Akira Hirano MD, PhD
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  2. Mari Kamimura MD
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  3. Kaoru Ogura MD
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  4. Naomi Kim MD
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  5. Akinori Hattori MD
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  6. Yumika Setoguchi MD
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  7. Fumie Okubo MD
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  10. Jun Kinoshita MD, PhD
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  11. Mariko Fujibayashi MD, PhD
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  12. Tadao Shimizu MD, PhD
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Corresponding author

Correspondence to Akira Hirano MD, PhD.

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Hirano, A., Kamimura, M., Ogura, K. et al. A Comparison of Indocyanine Green Fluorescence Imaging Plus Blue Dye and Blue Dye Alone for Sentinel Node Navigation Surgery in Breast Cancer Patients. Ann Surg Oncol 19, 4112–4116 (2012). https://doi.org/10.1245/s10434-012-2478-0

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  • DOI: https://doi.org/10.1245/s10434-012-2478-0

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