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Comparison of the Indocyanine Green Fluorescence and Blue Dye Methods in Detection of Sentinel Lymph Nodes in Early-stage Breast Cancer

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

Abstract

Purpose

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.

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Acknowledgment

We are grateful to the medical staff of the Translational Research Center, Kyoto University, for their valuable help and scientific advice.

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Authors and Affiliations

  1. Department of Breast Surgery, Kyoto University, Kyoto, Japan

    Tomoharu Sugie MD & Masakazu Toi MD

  2. Department of Breast Surgical Oncology, Showa University, Tokyo, Japan

    Terumasa Sawada MD

  3. Department of Surgery, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Japan

    Nobumi Tagaya MD

  4. Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan

    Takayuki Kinoshita  (MD)

  5. Department of Breast Surgery, Shinko Hospital, Kobe, Japan

    Kazuhiko Yamagami MD

  6. Department of Breast Surgery, Hyogo Prefectural Tsukaguchi Hospital, Amagasaki, Japan

    Hirofumi Suwa  (MD)

  7. Translation Research Center, Kyoto University Hospital, Kyoto, Japan

    Takafumi Ikeda PhD, Kenichi Yoshimura PhD, Miyuki Niimi PhD & Akira Shimizu MD

Authors
  1. Tomoharu Sugie MD
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  2. Terumasa Sawada MD
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  3. Nobumi Tagaya MD
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  4. Takayuki Kinoshita  (MD)
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  5. Kazuhiko Yamagami MD
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  6. Hirofumi Suwa  (MD)
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  7. Takafumi Ikeda PhD
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  8. Kenichi Yoshimura PhD
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  9. Miyuki Niimi PhD
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  10. Akira Shimizu MD
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  11. Masakazu Toi MD
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Corresponding author

Correspondence to Tomoharu Sugie MD.

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Sugie, T., Sawada, T., Tagaya, N. et al. Comparison of the Indocyanine Green Fluorescence and Blue Dye Methods in Detection of Sentinel Lymph Nodes in Early-stage Breast Cancer. Ann Surg Oncol 20, 2213–2218 (2013). https://doi.org/10.1245/s10434-013-2890-0

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  • DOI: https://doi.org/10.1245/s10434-013-2890-0

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