Evaluation of the efficacy of using indocyanine green associated with fluorescence in sentinel lymph node biopsy

• Published in: PloS one 2023-10, Vol.18 (10), p.e0273886
• Main Authors: da Silva Sá, Rafael, Von Ah Rodrigues, Raquel Fujinohara, Bugalho, Luiz Antônio, da Silva, Suelen Umbelino, Pinto Nazário, Afonso Celso
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Coloring Agents; Female; Humans; Indocyanine Green; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphadenopathy - pathology; Medicine and Health Sciences; People and Places; Research and Analysis Methods; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy - methods
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0273886

Sentinel lymph node biopsy is the technique recommended for the axillary staging of patients with breast cancer in the initial stages without clinical axillary involvement. Three techniques are widely used globally to detect sentinel lymph nodes: patent blue, the radiopharmaceutical technetium 99 with gamma probe, and the combination of these two. To evaluate the sentinel lymph node detection rate with an innovative technique: indocyanine green (ICG) associated with fluorescence in breast cancer patients, and compare it with patent blue and a combination of patent blue and indocyanine green. 99 patients were sequentially (not randomly) allocated into 3 arms with 33 patients submitted to sentinel lymph node techniques. One arm underwent patent blue dying, the other indocyanine green, and the third received a combination of both. The detection rates between arms were compared. The detection rate in identifying the sentinel lymph node was 78.8% with patent blue, 93.9% with indocyanine green, and 100% with the combination. Indocyanine green identified two sentinel nodes in 48.5% of patients; the other groups more commonly had only one node identified. The mean time to sentinel lymph node identification was 20.6 ± 10.7 SD (standard deviation) minutes among patients submitted to the patent blue dye, 8.6 ± 6.6 minutes in the indocyanine green arm, and 10 ± 8.9 minutes in the combined group (P