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. 2022 Sep;11(9):1489-1496.
doi: 10.21037/gs-22-434.

Evaluation of indocyanine green combined with methylene blue staining in sentinel lymph node biopsy of breast cancer

Yong Xu  1 , Songlin Yuan  1 , Mingtao Chen  1 , Ke Gong  1 , Youzhong Liu  1 , Shengyun Li  1 , Fang Xiong  1 , Yuejun Pan  1 , Jiyao Cao  1 , Jia Gong  1 , Na Luo  1
Affiliations

Evaluation of indocyanine green combined with methylene blue staining in sentinel lymph node biopsy of breast cancer

Yong Xu et al. Gland Surg. 2022 Sep.

Abstract

Background: Methylene blue as tracer used in sentinel lymph node biopsy (SLNB) have low detection rate and high false negative rate. Indocyanine green (ICG) can detect the flow of subcutaneous lymphatic vessels and the position of lymph nodes dynamically. This study sought to evaluate the efficacy of ICG combined with methylene blue staining in SLNB of breast cancer.

Methods: One hundred and fifty-six early breast cancer patients treated at our hospital from July 2020 to May 2022 were enrolled in this study. SLNB was performed by ICG combined with methylene blue staining under the guidance of the fluorescent tracer navigation system FLI-10B. Standard axillary lymph node dissection (ALND) was performed in patients with sentinel lymph node (SLN) metastasis confirmed by intraoperative frozen pathology, while low ALND was performed in patients with negative SLNs. According to the staining condition, the SLNs were divided into: (I) the combined group (SLNs with methylene blue staining and/or ICG luminescence); (II) the methylene blue group (SLNs with methylene blue staining alone); and (III) the ICG group (SLNs with ICG luminescence alone). The detection rate, accuracy, sensitivity, and false negative rate of SLNB were compared among the 3 groups.

Results: A total of 592 SLNs were detected in the combined group (average 3.8 SLNs), yielding a detection rate of 97.4%; the accuracy, sensitivity, and false negative rates were 97.4%, 92.7%, and 7.3%. In the methylene blue group, 390 SLNs were detected (average 2.5 SLNs), yielding a detection rate of 84.6%; the accuracy, sensitivity, and false negative rates were 83.3%, 89.1%, and 10.9%. A total of 483 SLNs were detected in the ICG group (average 3.1 SLNs), the detection rate was 92.9%; the accuracy, sensitivity and false negative rates were 91.7%, 90.9%, and 9.1%. The average number of detected SLNs, detection rate and accuracy rate in the combined group were higher than those in the methylene blue group (P<0.05), and the accuracy rate of the combined group was higher than that of the ICG group (P<0.05).

Conclusions: ICG combined with methylene blue staining is a promising and effective tracing strategy in the SLNB of breast cancer with high detection and accuracy rates.

Keywords: Breast cancer; fluorescent image navigation; indocyanine green (ICG); methylene blue; sentinel lymph node biopsy (SLNB).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-22-434/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Procedures of the workflow. ICG, indocyanine green; SLN, sentinel lymph node.
Figure 2
Figure 2
Lymphatic drainage imaging was used to trace lymph nodes.
See this image and copyright information in PMC

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