Breast Cancer

, Volume 12, Issue 3, pp 211–215 | Cite as

Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer

  • Toshiyuki Kitai
  • Takuya Inomoto
  • Mitsuharu Miwa
  • Takahiro Shikayama
Original article



Sentinel lymph node biopsy using a vital dye is a convenient and safe method to assess lymph node status in breast cancer. However, intensive training is necessary to obtain a satisfactory detection rate and to avoid false-negative results. This paper presents a novel method using indocyanine green fluorescence imaging to detect sentinel lymph nodes.


Fluorescence images were obtained using a charge coupled device camera with a cut filter as the detector, and light emitting diodes at 760 nm as the light source. When indocyanine green was injected around the areola, subcutaneous lymphatic channels draining from the areola to the axilla were visible by fluorescence within a few minutes. The sentinel lymph node was then dissected by fluorescence navigation.


Sentinel lymph node biopsy using the present method was performed on eighteen patients. Subcutaneous lymphatics were detectable by fluorescence in all patients, and sentinel nodes were successfully identified in 17 of 18 cases (detection rate: 94%). It was possible to detect the lymphatic channels and nodes receiving indocyanine green with higher sensitivity by the fluorescence signal than by the green color.


Sentinel node biopsy guided by indocyanine green fluorescence imaging is a promising technique for further clinical exploration.

Key words

Sentinel lymph node biopsy Breast cancer Indocyanine green Fluorescence imaging Navigation surgery 



Indocyanine green


Charge coupled device


Light emitting diode


Sentinel lympn node


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1).
    Hiram S, Cody IE: Sentinel lymph node mapping in breast cancer.Breast Cancer 6: 12–22,1999.Google Scholar
  2. 2).
    Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, Renne G, De Cicco C, De Lucia F, Gennari R: A randomized comparison of sentinelnode biopsy with routine axillary dissection in breast cancer.N EngJ Med 349: 546–553, 2003.CrossRefGoogle Scholar
  3. 3).
    NoguchiM: Is it necessary to perform prospective randomized studies before sentinel node biopsy can replace routine axillary dissection?Breast Cancer 10: 179–187, 2003.PubMedCrossRefGoogle Scholar
  4. 4).
    Giuliano AE, Kirgan DM, Guenther JM, Morton DL: Lymphatic mapping and sentinel lymphadecectomy for breast cancer.Ann Surg 220: 391–401,1994.PubMedCrossRefGoogle Scholar
  5. 5).
    Motomura K, Inaji H, Komoike Y, Kasugai T, Noguchi S, Koyama H: Sentinel Node biopsy guided by indocyanin green dye in breast cancer patients.Jpn J Clin Oncol 29: 604–607, 1999.PubMedCrossRefGoogle Scholar
  6. 6).
    Giuliano AE, Jones RC, Brennan M, Statman R: Sentinel lymphadenectomy in breast cancer.J Clin Oncol 15: 2345–2350,1997.PubMedGoogle Scholar
  7. 7).
    Motomura K, Inaji H, Komoike Y, Kasugai T, Ngumo S, Noguchi S, Koyama H: Sentinel node biopsy in breast cancer patients with clinically negative lymphnodes.Breast Cancer 6: 259–262, 1999.PubMedCrossRefGoogle Scholar
  8. 8).
    Borgstein PJ, Meijer S, Pijpers RJ, Diest PJ: Functional lymphatic anatomy for sentinel node biopsy in breast cancer. Echoes from the past and the periareolar blue method.Ann Surg 232: 81–89, 2000.PubMedCrossRefGoogle Scholar
  9. 9).
    Noguchi M: Sentinel lymph node biopsy in breast cancer: an overview of the Japanese experience.Breast Cancer 8: 184–193, 2001.PubMedCrossRefGoogle Scholar
  10. 10).
    Krag DN, Weaver OJ, Alex JC, Fairbank JT: Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe.Surg Oncol 2: 335–340,1993.PubMedCrossRefGoogle Scholar
  11. 11).
    Benson RC, Kues HA: Fluorescence properties of indocyanine green as related to angiography.Phys Med Biol 23: 159–163,1978.PubMedCrossRefGoogle Scholar
  12. 12).
    Kitai T, Miwa M, Liu H, Beauvoit B, Chance B, Yamaoka Y: Application of near-infrared time-resolved spectroscopy to rat liver — a preliminary report for surgical application.Phys Med Biol 44: 2049–2061, 1999.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2005

Authors and Affiliations

  • Toshiyuki Kitai
    • 1
  • Takuya Inomoto
    • 2
  • Mitsuharu Miwa
    • 3
  • Takahiro Shikayama
    • 3
  1. 1.Department of SurgeryNara Social Security HospitalJapan
  2. 2.Department of SurgeryOsaka Red Cross HospitalJapan
  3. 3.Central Laboratory, Hamamatsu PhotonicsJapan

Personalised recommendations