Application Of Indocyanine Green Combined With Dye In Sentinel Lymph Node Biopsy

Objective:To analyze the value of dual tracers(Indocyanine green and Methylene blue/Carbon Nanoparticles Suspension)in sentinel lymph node biopsy for breast cancer.Methods:A total of 70 breast cancer patients admitted to the Breast Center of the Fourth Hospital of Hebei Medical University from May 2019to August 2019 were selected.All patients underwent breast conserving surgery or simple breast resection plus sentinel lymph node biopsy.Sentinel lymph nodes were searched using indocyanine green combined with blue-stained/black-stained tracer intraoperatively.The fluorescent tracer is Indocyanine Green(ICG);the blue dye tracer is Methylene Blue(MB);and the black tracer is Carbon Nanoparticles Suspension Injection(CN).Sentinel lymph nodes were isolated and sent for pathological examination separately.The number and tracer situation of sentinel lymph nodes(SLNs)during operation were recorded separately for each patient.The data was analyzed by SPSS 21.0 software.The count data was expressed by rate(%),and the comparison was performed by?2 test.F test for comparison of the three.Statistically significant with P<0.05.Results:A total of 70 patients underwent SLNB operation with double tracer method(indocyanine green+methylene blue/nano carbon).Among them,50 patients underwent single mastectomy+SLNB operation and 20patients underwent breast conserving+SLNB operation.In the single cutting group,1 case did not find sentinel lymph node,the unsuccessful rate was 1.43%.The overall success rate was 98.57%,the success rate of single cutting+SLNB group was 98.00%,and the success rate of breast conserving+SLNB group was 100%.Among 70 patients,57(43+14)were detected by dye method(methylene blue/nanocarbon),the detection rate was 81.43%.65(47+18)were detected with indocyanine green,the detection rate was 92.86%.The detection rate of indocyanine green was higher,the difference was statistically significant(?~2=4.080,P=0.043).Among the 50patients in the single cutting+SLNB group,the detection rate of methylene blue was 86.0%(43/50),the detection rate of indocyanine green was94.0%(47/50),and the detection rate of indocyanine green was higher,but there was no significant difference between the two groups(?~2=1.778,P=0.182).In the group of breast conserving+SLNB,the detection rate of nanocarbon was 70.00%(14/20),and the detection rate of indocyanine green was 90.00%(18/20),but there was no significant difference between the two groups(P=0.235).A total of 203 sentinel lymph nodes were identified in 69 patients.1-4lymph nodes were found by ICG in each patient and the median lymph nodes was 3.1-4 lymph nodes were found for each person by using methylene blue and the median was 1.1-3 lymph nodes were found with nano carbon and the median was 1.5.The difference was statistically significant(F=9.096,P=0.000).Of the 69 patients,56 were pathologically negative and 13 were positive.There were 11 cases with dyed positive lymph nodes(including 6cases of blue staining in the single cutting+SLNB group and 5 cases of black staining in the breast conserving+SLNB group).There were 13 cases with fluorescent positive lymph nodes.Among them,7 cases were blue stained in the single cutting+SLNB group and 6 cases were black stained in the breast conserving+SLNB group..Conclusions:1.The detection rate of sentinel lymph nodes by fluorescent staining2.ICG is a good SLNB tracer and is worthy of widespread use.