Application Of Indocyanine Green Method Mediated By Optical Molecular Surgery Navigation System In Sentinel Lymph Node Biopsy Of Breast Cancer

Background:The current methods for sentinel lymph node biopsy (SLNB) of breast cancer mainly include the dye method, the radionuclide method and their combination method. These methods have many advantages also have some disadvantages. The combined method is recommended to be used in abroad to reduce the false negative rate and to improve the success rate. Currently domestic guidelines only support methylene blue method as the preferred method of SLNB for breast cancer. Optical molecular imaging technology is one of the hotspots in the field of biomedical research, some specific fluorescent dye is injected into the body to combine the biological macromolecules targeted, so that surface accurate positioning of lymphatic channels and sentinel lymph nodes (SLN) can be achieved by specialized testing equipment. Indocyanine green (ICG) is often to be used in this method. Some research suggest that using ICG method in SLNB of breast cancer has more advantages than the traditional methods, but more large-scale clinical trials still need to be carried out before the wide application of this technology.Objective:To test the clinical application value of combination use of ICG and optical molecular imaging surgical navigation system (SNS) for SLNB in breast cancer.Methods:74 patients with breast cancer were enrolled to perform SLNB with ICG and methylene blue method which guided by SNS. Quick frozen pathology confirmed sentinel lymph node metastasis, then axillary lymph node dissection (ALND) was performed, If the pathology results of SLNs were negative, ALND was avoided. The average number of detection, success rate, false negative rate, accuracy and sensitivity of different method were statistically analyzed.Results:In matching design of 39 cases, ICG method’s success rate was 92.3%, total 124 SLNs were resected, an average of 3.18 SLNs,100% sensitivity and the false negative rate was 0%; Methylene blue method’s success rate was 89.7%, total 71 SLNs were resected, an average of 1.8 SLNs, sensitivity 93.7%, false negative rate 6.3%. The average number of SLNs of ICG method is better than that of methylene blue method, the success rate and false negative rate were not bad effect in methylene blue method (noninferiority testing, p<0.05). In 35 cases which were performed by ICG method alone, ICG method’s success rate was 94.3%, total 111 SLNs were resected, an average of 3.17 SLNs, sensitivity 100%, false negative rate 0%.Conclusion:ICG method has a higher success rate, a lower false negative rate and a good accuracy, less dependent on operation experience and is easy to learn, also shorten the learning curve, clinical effect is better than methylene blue. Worthy of further application and expected to be applied in SLNB alone. In the trial process, SNS is stable, its image is clear, safe and reliable, effectively avoid the blindness of traditional operation, heralded the good application prospect of optical molecular imaging techniques in the field of minimally invasive surgery of breast cancer.