Skip to main content
SpringerLink
Log in

A Novel Indocyanine Green Fluorescence-Guided Video-Assisted Technique for Sentinel Node Biopsy in Breast Cancer

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The equipment to detect indocyanine green (ICG) fluorescence for sentinel lymph node (SLN) biopsy in breast cancer is not widely accessible nor optimal. The fluorescence appears as a poorly defined white shine on a black background, and dimmed lighting is required. The aim of this study was to assess the feasibility, accuracy and healthcare costs of a novel approach for SLN biopsy by a video-assisted ICG-guided technique.

Methods

The technique for detecting SLN was radioisotope (RI) in 194 cases, video-assisted ICG-guided in 70 cases and a combined method in 71 cases. In the video-assisted ICG group, a full HD laparoscopic system equipped with xenon lamps was used for a laser-free detection of ICG within a colored and magnified high-resolution image.

Results

Detection of ICG fluorescence using a laparoscope with a near-infrared filter provided a highly defined and colored image during SLN biopsy. SLN was identified in 100% of patients in all groups. Multiple SLNs were identified in 0.5% of RI patients, in 12.9% of ICG patients and in 14.1% of ICG + RI patients (p < 0.0001). In ICG + RI group, 95.1% of lymph nodes were radioactive and 92.7% were fluorescent. Operative times and healthcare costs were equivalent between groups.

Conclusions

Video-assisted ICG-guided technique is a feasible and surgeon-friendly method for SLN biopsy, with equivalent efficacy compared to RI, providing an accurate staging of the axilla.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cody HS (1999) Sentinel lymph node mapping in breast cancer. Breast Cancer 6:13–22

    Article  PubMed  CAS  Google Scholar 

  2. Peek MC, Charalampoudis P, Anninga B et al (2017) Blue dye for identification of sentinel nodes in breast cancer and malignant melanoma: a systematic review and meta-analysis. Future Oncol 13:455–467

    Article  PubMed  CAS  Google Scholar 

  3. Ahmed M, Purushotham AD, Douek M (2014) Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 15:e351–e362

    Article  PubMed  Google Scholar 

  4. Ahmed M, Purushotham AD, Horgan K et al (2015) Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer. Br J Surg 102:169–181

    Article  PubMed  CAS  Google Scholar 

  5. Niebling MG, Pleijhuis RG, Bastiaannet E et al (2016) A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping. Eur J Surg Oncol 42:466–473

    Article  PubMed  CAS  Google Scholar 

  6. Alhussini MA, Awad AT, Ashour MH et al (2016) Breast cancer sentinel node detection: an alternative solution for centers lacking nuclear technology. Breast Care 11:265–268

    Article  PubMed  PubMed Central  Google Scholar 

  7. Derossis AM, Fey JV, Cody HS et al (2003) Obesity influences outcome of sentinel lymph node biopsy in early-stage breast cancer. J Am Coll Surg 197:896–901

    Article  PubMed  Google Scholar 

  8. Morrow M, Rademaker AW, Bethke KP et al (1999) Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 126:714–720

    Article  PubMed  CAS  Google Scholar 

  9. Kitai T, Inomoto T, Miwa M et al (2005) Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer 12:211–215

    Article  PubMed  Google Scholar 

  10. Sugie T, Kassim KA, Takeuchi M et al (2010) A novel method for sentinel lymph node biopsy by indocyanine green fluorescence technique in breast cancer. Cancers 2:713–720

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sugie T, Ikeda T, Kawaguchi A et al (2017) Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer: a meta-analysis. Int J Clin Oncol 22:11–17

    Article  PubMed  CAS  Google Scholar 

  12. Troyan SL, Kianzad V, Gibbs-Strauss SL et al (2009) The FLARE intraoperative near-infrared fluorescence imaging system: a first-in-human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol 16:2943–2952

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hirche C, Murawa D, Mohr Z et al (2010) ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat 121:373–378

    Article  PubMed  Google Scholar 

  14. Wishart GC, Loh SW, Jones L et al (2012) A feasibility study (ICG-10) of indocyanine green (ICG) fluorescence mapping for sentinel lymph node detection in early breast cancer. Eur J Surg Oncol 38:651–656

    Article  PubMed  CAS  Google Scholar 

  15. Toh U, Iwakuma N, Mishima M et al (2015) Navigation surgery for intraoperative sentinel lymph node detection using Indocyanine green (ICG) fluorescence real-time imaging in breast cancer. Breast Cancer Res Treat 153:337–344

    Article  PubMed  CAS  Google Scholar 

  16. Coufal O, Fait V (2016) Use of indocyanine green and the HyperEye system for detecting sentinel lymph nodes in breast cancer within a population of European patients: a pilot study. World J Surg Oncol 14:299

    Article  PubMed  PubMed Central  Google Scholar 

  17. Martin RC, Edwards MJ, Wong SL et al (2000) Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. For the University of Louisville Breast Cancer Study Group. Surgery 128(2):139–144

    Article  PubMed  Google Scholar 

  18. Tong M, Guo W, Gao W (2014) Use of fluorescence imaging in combination with patent blue dye versus patent blue dye alone in sentinel lymph node biopsy in breast cancer. J Breast Cancer 17:250–255

    Article  PubMed  PubMed Central  Google Scholar 

  19. Samorani D, Fogacci T, Panzini I et al (2015) The use of indocyanine green to detect sentinel nodes in breast cancer: a prospective study. Eur J Surg Oncol 41:64–70

    Article  PubMed  CAS  Google Scholar 

  20. Sugie T, Kinoshita T, Masuda N et al (2016) Evaluation of the clinical utility of the ICG fluorescence method compared with the radioisotope method for sentinel lymph node biopsy in breast cancer. Ann Surg Oncol 23:44–50

    Article  PubMed  Google Scholar 

  21. Zhang X, Li Y, Zhou Y et al (2016) Diagnostic performance of indocyanine green-guided sentinel lymph node biopsy in breast cancer: a meta-analysis. PLoS ONE 11:e0155597

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Guo J, Yang H, Wang S et al (2017) Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: a prospective cohort study. World J Surg Oncol 15:196

    Article  PubMed  PubMed Central  Google Scholar 

  23. Boni L, David G, Mangano A et al (2015) Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc 29:2046–2055

    Article  PubMed  Google Scholar 

  24. Jung SY, Kim SK, Kim SW et al (2014) Comparison of sentinel lymph node biopsy guided by the multimodal method of indocyanine green fluorescence, radioisotope, and blue dye versus the radioisotope method in breast cancer: a randomized controlled trial. Ann Surg Oncol 21:1254–1259

    Article  PubMed  Google Scholar 

  25. Grischke EM, Röhm C, Hahn M et al (2015) ICG fluorescence technique for the detection of sentinel lymph nodes in breast cancer: results of a prospective open-label clinical trial. Geburtshilfe Frauenheilkd 75:935–940

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. All the authors reported no acknowledgements.

Author information

Authors and Affiliations

  1. Surgery Division, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, via G. B. Grassi 74, 20157, Milan, Italy

    Luca Sorrentino, Alessandra Sartani, Gaia Pietropaolo & Diego Foschi

  2. Surgery Department, Breast Unit, ICS Maugeri S.p.A. SB, via Maugeri 10, 27100, Pavia, Italy

    Daniela Bossi & Fabio Corsi

  3. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy

    Serena Mazzucchelli, Marta Truffi, Diego Foschi & Fabio Corsi

Authors
  1. Luca Sorrentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandra Sartani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaia Pietropaolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniela Bossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Serena Mazzucchelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marta Truffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Diego Foschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fabio Corsi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabio Corsi.

Ethics declarations

Conflict of interest

All the authors reported no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sorrentino, L., Sartani, A., Pietropaolo, G. et al. A Novel Indocyanine Green Fluorescence-Guided Video-Assisted Technique for Sentinel Node Biopsy in Breast Cancer. World J Surg 42, 2815–2824 (2018). https://doi.org/10.1007/s00268-018-4534-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4534-9

Search

Navigation