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Long-term results of fluorescence and indigo carmine blue dye-navigated sentinel lymph node biopsy

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Abstract

Background

Sentinel lymph node biopsy is widely applied for the management of clinically node-negative breast cancer, and a radioisotope with a blue dye are most often used as tracers. Fluorescence of indocyanine green could also potentially be used as tracer. This study aimed to demonstrate the long-term survival results of fluorescence-guided sentinel lymph node biopsy.

Patients and methods

Patients with clinically node-negative breast cancer who underwent surgery as initial treatment were included in this study. Both fluorescence of indocyanine green and indigo carmine blue dye were used as tracers. Axillary lymph node dissection was omitted unless metastasis was pathologically proven in sentinel nodes. Breast cancer recurrence and death were recorded and prognostic factors were identified using disease-free survival and overall survival data.

Results

A total of 565 patients were analyzed. There were 14 (2.5%) patients whose sentinel nodes could not be identified, yielding an identification rate of 97.5%. Axillary dissection was performed in 90 patients. Forty-three recurrences including 6 ipsilateral axilla recurrence and 13 deaths were observed during the median 83 months of follow-up period. Seven-year disease-free and overall survival were 92.4% and 97.3%, respectively. Multivariate analyses demonstrated that pre-menopausal status and invasive lobular carcinoma were significant unfavorable prognostic factors of disease-free survival. Half of ipsilateral axilla recurrences occurred within 5 years after surgery and these recurrences were correlated with inappropriate adjuvant therapy.

Conclusion

Fluorescence-guided sentinel lymph node biopsy demonstrated favorable prognostic results and could be alternative to the radioisotope for clinically node-negative breast cancer.

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Acknowledgements

The authors thank all our colleagues who helped us with outcome data collection. There was no financial or funding support for this study.

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Authors and Affiliations

  1. Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Sota Asaga, Ai Tsuchiya, Yoshiharu Ishizaka, Kaisuke Miyamoto, Hiroki Ito, Hirotsugu Isaka & Shigeru Imoto

  2. Department of Breast Surgery, Kaneko Clinic, 8-6 Uearata-cho, Kagoshima, Kagoshima, 890-0055, Japan

    Hiroki Ito

  3. Department of Pathology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Tomohiro Chiba & Hiroshi Kamma

  4. Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto Ward, Tokyo, 135-8550, Japan

    Tomohiro Chiba

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  1. Sota Asaga
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Correspondence to Sota Asaga.

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Asaga, S., Tsuchiya, A., Ishizaka, Y. et al. Long-term results of fluorescence and indigo carmine blue dye-navigated sentinel lymph node biopsy. Int J Clin Oncol 26, 1461–1468 (2021). https://doi.org/10.1007/s10147-021-01925-9

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