Use Of Indocyanine Green In Combination With Methylene Blue Dye Versus Methylene Blue Dye Alone In Sentinel Lymph Node Biopsy In Breast Cancer

Purpose: The axillary lymph node status is the most significant prognostic factor in patients with breast cancer. Sentinel lymph node biopsy is a well-established method for evaluating axillary node status. Sentinel lymph node biopsy has become the standard operation in clinic. Its application is replacing axillary dissection. Selecting the appropriate and accurate positioning of tracer, surgeons can increase the success rate and shorten the learning curve in the sentinel lymph node biopsy, and more conducive to the promotion in the primary hospital. Near-infrared fluorescence imaging using indocyanine green(ICG) has the potential to improve sentinel lymph node(SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye and that of blue dye alone for detecting SLNs.Methods: Patients with a confirmed pathological diagnosis of early-stage breast cancer at the Breast Center of Dalian Central Hospital. Patients undergoing SLN biopsy(SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected using Methylene blue(MB) alone and since January 2012, using MB in combination with ICG. The patients were divided into group A(ICG-MB; n = 96) and group B(MB; n = 73), SLN detection parameters were compared between the groups. Sentinel lymph nodes removed in the operation sent for frozen section pathological examination and routine paraffin immunohistochemical pathological examination. All patients underwent level I and II axillary dissections after SLNB.Results: In group A, the SLN detection rate was 96.9%(93/96), the accuracy of detection was 98.9%(92/93), and the false-negative rate(FNR) was 3.4%(1/29). In group B, the SLN detection rate was 84.9%(62/73), the accuracy of detection was 96.8%(60/62), and the FNR was 11.1%(2/18). The average number of SLNs detected in group A(3.8±0.9) was higher than that detected in group B(2.4±0.7). The ICG-MB group showed significantly superior results compared to the MB group for SLN detection(p = 0.005) and greatly improved the FNR.Conclusion: The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.