Near-infrared laparoscopy with indocyanine green for axillary sentinel lymph node biopsy in early breast cancer: preliminary experience of a single unit

Abstract

Background: A sentinel lymph node biopsy (SLNB) is a routine procedure for axillary staging in cN0 breast cancer (BC) patients. Indocyanine green (ICG) fluorescence can detect sentinel lymph nodes with higher sensitivity than carbon nanoparticle suspension (CNS). The present study investigated the availability and benefits of a near-infrared (NIR) laparoscopy-assisted SLNB using ICG and carbon nanoparticle suspension as tracers.Methods: Forty patients with invasive BC, who had clinically negative axillary lymph nodes, participated in this observational study. ICG and CNS tracers were injected into the periareolar region simultaneously or sequentially. In the endoscopy-assisted group (n=20), the patients were given NIR laparoscopic SLNB based on ICG fluorescence and CNS staining. In the open-surgery group, the patients were given traditional SLNB using an open incision, and CNS tracers were injected into the same region as that in the endoscopyassisted group.Results: In the endoscopy-assisted group, lymphatic vessels and sentinel lymph nodes (SLNs) were successfully identified using ICG fluorescence imaging in most patients (19/20). The average number of SLNs removed was 2.85 (range, 1-4) in the endoscopy-assisted group, and 3.40 (range, 1-7) in the opensurgery group. There was no significant difference between the number of detected nodes (P=0.30). The patients who underwent endoscopy-assisted SLNBs had similar operating times, blood loss and hospital-stay lengths, but lower postoperative drainage volumes and higher satisfaction scores, as they did not have axillary incisions. Conclusions:The NIR laparoscopy-assisted ICG-guided technique is a feasible and surgeon-friendly method for SLNB with good efficacy and acceptable safety. When combined with CNS, more SLNs can be detected and dissected.

Comparison of Sentinel Lymph Node Biopsy by Blue Dye Conjunction With Indocyanine Green or Radioisotope in Early-Stage Breast Cancer: A Prospective Single-Center Observational Study

“…Indocyanine green, a nonallergenic and nonradioactive fluorescent dye, has been proposed as an effective tracer for SLN identification in breast cancer. [10][11][12] It is well known that the SLN detection rates of ICG are superior to those of BD 15 ; however, the efficiency in SLN identification between ICG and RI method is controversial. Stoffels et al 16 found the use of ICG for SLN detection to be inferior compared with RI technique especially in patients in whom the lymph node basin cannot be predicted correctly.…”

“…Indocyanine green, a nonallergenic and nonradioactive fluorescent dye, has been proposed as an effective tracer for SLN identification in breast cancer. 10-12…”

“…Kitai et al 9 first employed a new technique for lymphatic 2 Clinical Medicine Insights: Oncology mapping using ICG in breast cancer. Although more studies have supported that the ICG technique is a safe and feasible method for SLN biopsy, [10][11][12] the comparable results on SLN detection rate between ICG + BD and RI + BD were inconsistent, which need more probe. Therefore, the present study was designed to prospectively assess the concordance between the ICG + BD (ICG-B) method and the 99 mTc-labeled radiotracer RI + BD (RI-B) method to determine the efficacy of ICG to identify the SLN.…”

Comparison of single-pore non-liposuction near-infrared laparoscopy with conventional open surgery for axillary sentinel lymph node biopsy in patients with early breast cancer: a single-center, small-sample retrospective study

“…Can these be applied for non-liposuction SLNB? At present, no relevant reports have been published domestically or internationally, and only a few studies have been reported on SLNB by NIR endoscopy with the liposuction method [ 11 ]. The tumor safety of the liposuction method remains controversial [ 6 , 7 ].…”

“…The patient was sedated, and 10–15 min prior to surgery, 0.5 mL of 0.5 mg/mL diluted ICG solution was administered subcutaneously at the 12 o’clock and 6 o’clock positions in the areola of the affected side, and the injection site was gently rubbed for 5 min. Then, 0.5 mL of 50% CNS was injected subcutaneously at the 3 o’clock and 9 o’clock positions in the areola of the affected side, and the site was gently rubbed for 5 min [ 11 ]. The subcutaneous ICG luminous-lymphatic vessels (Fig.…”