Non-Invasive Identification of Sentinel Lymph Nodes Using Indocyanine Green Fluorescence Imaging in Patients with Breast Cancer

ABSTRACT

Background:

Recently, sentinel lymph node biopsy (SLNB) has been carried out routinely in patients with early breast cancer. Avoidance of axillary lymph node dissection is considerably desirable items of maximizing the quality of life of postoperative patients Here we report non-invasive identification of SLN using indocyanine green (ICG) fluorescence imaging, which provides a high detection rate and a low false-negativity rate.

Patients and Methods:

One hundred and fifty breast cancer patients with tumors less than 3 cm in diameter were enrolled in this study. ICG dye and indigo carmine were injected subdermally at the same time into the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were immediately rendered visible by fluorescence imagings using a Photodynamic Eye (PDE). After incising the axillary skin over the location of the LN identified by ultrasonography, the SLN was dissected under fluorescence imaging guidance with adequate adjustment of sensitivity

Results:

Lymphatic channels and SLN were successfully identified in all patients. The mean number of SLN and the operation time for SLNB were 3.2 and 15.2 min, respectively. Twenty-six patients (17.3%) were found to have lymph node metastases pathologically. Adjustment of the sensitivity of PDE facilitated a reduction in the operation time. There were no intra- or postoperative complications associated with SLN identification.

Conclusions:

This method is feasible, safe, and only minimally invasive for intraoperative detection of SLN, allowing real-time observation without any need for training.

Keywords:

Image overlay surgery, sentinel lymph node biopsy, breast cancer, navigation surgery, fluorescence imaging.