An Application Study Of Indocyanine Green Fluorescence Combine With Blue Dye For Sentinel Lymph Node Biopsy In Breast Cancer Patients

Purpose:To investigate the value of clinical application to use indocyanine green fluorescence combine with blue dye method compare with ICG method for SLNB in breast cancer patients.Methods:Between March of 2013 and February of 2015, 76 female patients diagnosed with early breast cancer which were comply with the test conditions. Two tracers of indocyanine green and methylene blue were injected into areola and tumor skin subcutaneous respectively.A sentinel lymph node biopsy was operated after the drug into the subcutaneous lymphatic fully.The first lymph node was considered as the sentinel lymph node(SLN) when it was stained with blue dye and/or fluorescence.A axillary lymph node dissection was operated after the SLNB and marking the SLN according to the characteristics of different tracer,then send to the Department of pathology with axillary lymph nodes to use the biopsy and H&E staining histologic examination in order to inspection of axillary node status.Patient data were recorded into a database and statistically analysed using SPSS Software(16.0).Results: 75 patients, SLNs were identified successfully,one patient lost.But in this patient whose SLN was not found and her axillary dissection confirmed that there was no positive lymph node.The SLN identification rate was 98.7%(75/76 patients).In 4 patients, SLNs were identified by methylene blue alone and in 9 patients they were identified by ICG alone. So the identification rate by blue alone would have been 86.8%(66/77). In contrast, if ICG alone was used,the identification rate would have been 93.4%(71/76). There was no significant difference between ICG-methylene blue combination and ICG alone on SLN identification(98.7% vs 93.4% P=0.052).In 25 patients with positive axillary lymph nodes,24 patients Metastatic involvement of SLNs was identified by ICG-methylene blue.There was one false-negative case.so the false-negative rate of 4%(1/25) by ICG-methylene blue combination method.In the 25 patients,2 patients positive SLNs were identified by methylene blue alone and 3 patients were identified by ICG alone. therefore,If blue dye alone was used,the positive lymph nodes would have been lost in 4 patients, resulting in a false-negative rate of 16%(4/25).If ICG was used, the resulting in a false-negative rate of 12%(3/25).There were 276 SLNs in 76 patients.27 were fluorescent,66 were blue,183 were fluorescent and blue,the max were 5 SLNs and the min were 1 SLN.So the average number of SLNs detected in the ICG-methylene blue combination method was 3.7 nodes(276/75)higher than in the ICG group 2.8 nodes(210/75).Conclusion: In this study, There was no significant difference between two tracers(ICG、methylene blue combination and ICG alone on SLN identification(P=0.052),that means each method was acceptable in the side of SLN identification rate.But dual tracer could help reduce the false negative rate significantly(12%~4%). And in the side of average number of SLNs detected,the ICG-methylene blue combination method was higher than in the ICG group,this can be help increasing the accuracy of assessment of nodal status.Therefore, this method using indocyanine green fluorescence combine with blue dye compare with ICG alone in SLNB could enhance the identification rate,improve the accuracy of assessment and reduce the false negative rate. It also an ideal choice that compare with the traditional method such as radiation-based detection methods which is full of radioactive safety hazards.Combine with indocyanine green fluorescence and blue dye has great potential and broad prospects for development in the current several operations of SLNB,where is the future direction of the localization technology.