Sentinel lymph node biopsy for breast cancer patients using fluorescence navigation with indocyanine green

Abstract

BackgroundThere are various methods for detecting sentinel lymph nodes in breast cancer. Sentinel lymph node biopsy (SLNB) using a vital dye is a convenient and safe, intraoperatively preparative method to assess lymph node status. However, the disadvantage of the dye method is that the success rate of sentinel lymph node detection depend on the surgeon's skills and preoperative mapping of the sentinel lymph node is not feasible. Currently, a vital dye, radioisotope, or a combination of both is used to detect sentinel nodes. Many surgeons have reported successful results using either method. In this study we have analyzed breast lymphatic drainage pathways using indocyanine green (ICG) fluorescence imaging.MethodsWe examined the lymphatic courses, or lymphatic vessels, in the breast using ICG fluorescence imaging, and applied this method to SLNB in patients who underwent their first operative treatment for breast cancer between May 2006 and April 2008. Fluorescence images were obtained using a charge coupled device camera with a cut filter used as a detector, and light emitting diodes at 760 nm as a light source. When ICG was injected into the subareola and periareola, subcutaneous lymphatic vessels from the areola to the axilla became visible by fluorescence within a few minutes. The sentinel lymph node was then dissected with the help of fluorescence imaging navigation.ResultsThe detection rate of sentinel nodes was 100%. 0 to 4 states of lymphatic drainage pathways from the areola were observed. The number of sentinel nodes was 3.41 on average.ConclusionsThis method using indocyanine green (ICG) fluorescence imaging may possibly improve the detection rate of sentinel lymph nodes with high sensitivity and compensates for the deficiencies of other methods. The ICG fluorescence imaging technique enables observation of breast lymph vessels running in multiple directions and easily and accurately identification of sentinel lymph nodes. Thus, this technique can be considered useful.

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

“…Thus, SLNs were identified and resected more rapidly and easily by introducing FI. 17 Especially in cases with multiple lymph drainage pathways, FI can detect multiple SLNs.…”

Optimal settings and accuracy of indocyanine green fluorescence imaging for sentinel node biopsy in early gastric cancer

“…With the recent invention of useful devices such as the Photodynamic Eye (PDE) and Hyper Medical Eye System, ICG fluorescence imaging for SN biopsy has been widely used in various cancer surgeries (18)(19)(20)(21)(22)(23)(24)(25)(26)(27). ICG fluorescence imaging has unique characteristics, including an extra-high sensitivity (26,28) and signal stability (23,26,28).…”

New Technologies in Breast Cancer Surgery

“…Recently published data has shown an excellent detection rate for ICG alone of 100%, ICG and blue dye of 95.0%, ICG radioisotope of 77.2%, and ICG and blue dye and radioisotope of 73.1% [18]. Another study presented a detection rate for ICG of also 100% [19]. If such results are reproducible, then the future use of ICG for detecting SLNs will become more and more common.…”