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Sentinel lymph node detection by means of indocyanine green using the Karl Storz VITOM® fluorescence camera: a comparison between primary sentinel lymph node biopsy versus sentinel lymph node biopsy after neoadjuvant chemotherapy

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

The usage of radioactive Technetium99m (Tc99m) colloid for the purpose of sentinel lymph node biopsy (SLNB) in early breast cancer is considered the gold standard in Germany. However, new tracers, such as near-infrared (NIR) imaging agents like indocyanine green (ICG) could offer an alternative in future, as they overcome drawbacks associated with radioactive Technetium99m (Tc99m) like limited availability, high costs and radioactivity exposure for both patients and surgeons.

Methods

In this double-arm retrospective study, we sought to establish the usefulness of indocyanine green as an alternative or an addition to the conventional Technetium99m (Tc99m) in the identification of the SLN in early breast cancer.

Results

Among the 161 patients who underwent primary SLNB, 34 patients had at least 1 SLN with metastasis. Among these patients with SLN metastasis, 33 had the SLN detected by ICG; while 31 had the SLN detected by Tc99m. The conventional Technetium99m radiotracer failed to detect 2 patients with metastasis in this Arm of the study. Among the 87 patients who underwent SLNB after NACT, 13 patients had at least 1 SLN with metastasis. Among these 13 patients with SLN metastasis, ICG and Tc99m had detected the SLN among 12 patients, while 1 patient had been detected by ICG alone.

Conclusions

Our results show that ICG is as effective as the radioisotope for SLNB even among patients who have undergone NACT. This trial is registered with the German Clinical Trial Register, ID: DRKS00013606.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, St. Marien Hospital, Amberg, Germany

    Petronilla Staubach, Anton Scharl & Thomas Papathemelis

  2. Department of Obstetrics and Gynecology, University Hospital Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany

    Atanas Ignatov, Olaf Ortmann & Elisabeth C. Inwald

  3. Department of Obstetrics and Gynecology, University Hospital Erlangen-Nuremberg, Maximilianspl. 2, 91054, Erlangen, Germany

    Thomas Hildebrandt

  4. Tumor Center of the University of Regensburg, Institute for Quality Assurance and Health Services Research, Regensburg, Germany

    Michael Gerken & Monika Klinkhammer-Schalke

  5. Department of Radiooncology and Radiotherapy, Technical University Hospital Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Sophia Scharl

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  1. Petronilla Staubach
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  2. Anton Scharl
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Correspondence to Petronilla Staubach.

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Staubach, P., Scharl, A., Ignatov, A. et al. Sentinel lymph node detection by means of indocyanine green using the Karl Storz VITOM® fluorescence camera: a comparison between primary sentinel lymph node biopsy versus sentinel lymph node biopsy after neoadjuvant chemotherapy. J Cancer Res Clin Oncol 147, 1813–1823 (2021). https://doi.org/10.1007/s00432-020-03461-x

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