Comparison between the indocyanine green fluorescence and blue dye methods for sentinel lymph node biopsy using novel fluorescence image-guided resection equipment in different types of hospitals

• Published in: Translational research : the journal of laboratory and clinical medicine 2016-12, Vol.178, p.74-80
• Main Authors: He, Kunshan, Chi, Chongwei, Kou, Deqiang, Huang, Wenhe, Wu, Jundong, Wang, Yabing, He, Lifang, Ye, Jinzuo, Mao, Yamin, Zhang, Guo-Jun, Wang, Jiandong, Tian, Jie
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Fluorescence; Hospitals; Humans; Image-Guided Biopsy - methods; Indocyanine Green - metabolism; Internal Medicine; Intraoperative Care; Methylene Blue - metabolism; Middle Aged; Sentinel Lymph Node - pathology; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy - instrumentation; Sentinel Lymph Node Biopsy - methods
• ISSN: 1931-5244; 1878-1810
• DOI: 10.1016/j.trsl.2016.07.010

Abstract Sentinel lymph node biopsy (SLNB) has become a standard of care to detect axillary lymph metastasis in early-stage breast cancer patients with clinically negative axillary lymph nodes (ALNs). Current SLNB detection modalities comprising a blue dye, a radioactive tracer, or a combination of both have advantages as well as disadvantages. Thus, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has recently been regarded as a novel method that has generated interest for SLNB around the world. However, the lack of appropriate fluorescence imaging systems has hindered further research and wide application of this method. Therefore, we developed novel fluorescence image-guided resection equipment (FIRE) to detect sentinel lymph nodes (SLNs). Moreover, to compare the ICG fluorescence imaging method with the blue dye method and to explore the universal feasibility of the former, a different type of hospital study was conducted. Ninety-nine eligible patients participated in the study at three different types of hospitals. After subcutaneous ICG allergy testing, all the patients were subcutaneously injected with methylene blue (MB) and ICG into the subareolar area. Consequently, 276 SLNs (range 1–7) were identified in 98 subjects (detection rate: 99%) by using the ICG fluorescence imaging method. In contrast, the blue dye method only identified 202 SLNs (range 1–7) in 91 subjects (detection rate: 91.92%). Besides, the results of the fluorescence imaging method were similar in the three hospitals. Our findings indicate the universal feasibility of the ICG fluorescence imaging method for SLNB using the FIRE in early breast cancer detection.