Skip to main content

Advertisement

SpringerLink
Log in

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background: Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. Methods: Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. Results: Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. Conclusion: ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.

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

Abbreviations

ALND:

Axillary lymph node dissection

ICG:

Indocyanine green

SLN:

Sentinel lymph node

References

  1. Bonnema J, van de Velde CJ (2002) Sentinel lymph node biopsy in breast cancer. Ann Oncol 13:1531–1537

    Article  CAS  PubMed  Google Scholar 

  2. Zavagno G, De Salvo GL, Scalco G et al (2008) A Randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg 247:207–213

    Article  PubMed  Google Scholar 

  3. Cox CE, Pendas S, Cox JM et al (1998) Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 227:645–651

    Article  CAS  PubMed  Google Scholar 

  4. Langer I, Guller U, Hsu-Schmitz SF et al (2009) Sentinel lymph node biopsy is associated with improved survival compared to level I & II axillary lymph node dissection in node negative breast cancer patients. Eur J Surg Oncol 35(8):805–813

    CAS  PubMed  Google Scholar 

  5. Giuliano AE, Jones RC, Brennan M, Statman R (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15:2345–2350

    CAS  PubMed  Google Scholar 

  6. Liberman L (2000) Pathologic analysis of sentinel lymph nodes in breast carcinoma. Cancer 88:971–977

    Article  CAS  PubMed  Google Scholar 

  7. Maaskant AJ, van de Poll-Franse LV, Voogd AC et al (2009) Stage migration due to introduction of the sentinel node procedure: a population-based study. Breast Cancer Res Treat 113:173–179

    Article  CAS  PubMed  Google Scholar 

  8. Fleissig A, Fallowfield LJ, Langridge CI et al (2006) Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 95:279–293

    Article  PubMed  Google Scholar 

  9. Sardi A, Spiegler E, Colandrea J et al (2002) The benefit of using two techniques for sentinel lymph node mapping in breast cancer. Am Surg 68:24–28

    PubMed  Google Scholar 

  10. Upponi SS, McIntosh SA, Wishart GC et al (2002) Sentinel lymph node biopsy in breast cancer—is lymphoscintigraphy really necessary? Eur J Surg Oncol 28:479–480

    CAS  PubMed  Google Scholar 

  11. Dauphine CE, Khalkhali I, Vargas MP et al (2006) Intraoperative injection of technetium-99 m sulfur colloid is effective in the detection of sentinel lymph nodes in breast cancer. Am J Surg 192:423–426

    Article  CAS  PubMed  Google Scholar 

  12. Stratmann SL, McCarty TM, Kuhn JA (1999) Radiation safety with breast sentinel node biopsy. Am J Surg 178:454–457

    Article  CAS  PubMed  Google Scholar 

  13. Rutgers EJ (2005) Guidelines to assure quality in breast cancer surgery. Eur J Surg Oncol 31:568–576

    Article  PubMed  Google Scholar 

  14. Aydogan F, Celik V, Uras C et al (2008) A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg 195:277–278

    Article  PubMed  Google Scholar 

  15. Raut CP, Hunt KK, Akins JS et al (2005) Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis: results of a surgical prospective clinical practice protocol. Cancer 104:692–699

    Article  CAS  PubMed  Google Scholar 

  16. Wilke LG, McCall LM, Posther KE et al (2006) Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol 13:491–500

    Article  PubMed  Google Scholar 

  17. Cox CE, Bass SS, Reintgen DS (1999) Techniques for lymphatic mapping in breast carcinoma. Surg Oncol Clin North Am 8:447–468

    CAS  Google Scholar 

  18. Sandrucci S, Casalegno PS, Percivale P et al (1999) Sentinel lymph node mapping and biopsy for breast cancer: a review of the literature relative to 4791 procedures. Tumori 85:425–434

    CAS  PubMed  Google Scholar 

  19. Ogasawara Y, Ikeda H, Takahashi M et al (2008) Evaluation of breast lymphatic pathways with indocyanine green fluorescence imaging in patients with breast cancer. World J Surg 32(9):1924–1929

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Meyer JS (1998) Sentinel lymph node biopsy: strategies for pathologic examination of the specimen. J Surg Oncol 69:212–218

    Article  CAS  PubMed  Google Scholar 

  22. Carter CL, Allen C, Henson DE (1989) Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63:181–187

    Article  CAS  PubMed  Google Scholar 

  23. Layeequr RR, Siegel E, Boneti C et al (2009) Stage migration with sentinel node biopsy in breast cancer. Am J Surg 197:491–496

    Article  Google Scholar 

  24. McIntosh SA, Ravichandran D, Balan KK (2001) Sentinel lymph node biopsy in impalpable breast cancer. Breast 10:82–83

    Article  CAS  PubMed  Google Scholar 

  25. Woznick A, Franco M, Bendick P, Benitez PR (2006) Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal? Am J Surg 191:330–333

    Article  PubMed  Google Scholar 

  26. Tagaya N, Yamazaki R, Nakagawa A et al (2008) Intraoperative identification of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer. Am J Surg 195:850–853

    Article  PubMed  Google Scholar 

  27. Murawa D, Hirche C, Dresel S, Hunerbein M (2009) Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence. Br J Surg 96:1289–1294

    Article  CAS  PubMed  Google Scholar 

  28. Tafra L, Lannin DR, Swanson MS et al (2001) Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 233:51–59

    Article  CAS  PubMed  Google Scholar 

  29. Motomura K, Inaji H, Komoike Y et al (1999) Sentinel node biopsy guided by indocyanine green dye in breast cancer patients. Jpn J Clin Oncol 29:604–607

    Article  CAS  PubMed  Google Scholar 

  30. Hama Y, Koyama Y, Urano Y et al (2007) Simultaneous two-color spectral fluorescence lymphangiography with near infrared quantum dots to map two lymphatic flows from the breast and the upper extremity. Breast Cancer Res Treat 103:23–28

    Article  PubMed  Google Scholar 

  31. Cserni G, Bianchi S, Vezzosi V (2008) Variations in sentinel node isolated tumour cells/micrometastasis and non-sentinel node involvement rates according to different interpretations of the TNM definitions. Eur J Cancer 44:2185–2191

    Article  PubMed  Google Scholar 

  32. Stitzenberg KB, Calvo BF, Iacocca MV et al (2002) Cytokeratin immunohistochemical validation of the sentinel node hypothesis in patients with breast cancer. Am J Clin Pathol 117:729–737

    PubMed  Google Scholar 

  33. Patani N, Mokbel K (2009) The clinical significance of sentinel lymph node micrometastasis in breast cancer. Breast Cancer Res Treat 114:393–402

    Article  PubMed  Google Scholar 

  34. Langer I, Guller U, Berclaz G et al (2009) Accuracy of frozen section of sentinel lymph nodes: a prospective analysis of 659 breast cancer patients of the Swiss multicenter study. Breast Cancer Res Treat 113:129–136

    Article  PubMed  Google Scholar 

  35. Chung MA, Steinhoff MM, Cady B (2002) Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsy. Am J Surg 184:310–314

    Article  PubMed  Google Scholar 

  36. Bergkvist L, de Boniface J, Jonsson PE et al (2008) Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study. Ann Surg 247:150–156

    Article  PubMed  Google Scholar 

  37. Langer I, Marti WR, Guller U et al (2005) Axillary recurrence rate in breast cancer patients with negative sentinel lymph node (SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg 241:152–158

    PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by grants from the Charite-Universitaetsmedizin Berlin, Germany.

Author information

Authors and Affiliations

  1. Department of General Surgery and Surgical Oncology, Robert-Rössle-Klinik, Helios Hospital Berlin-Buch, CCB, 13125, Berlin, Germany

    Christoph Hirche, Dawid Murawa, Zarah Mohr, Soeren Kneif & Michael Hünerbein

Authors
  1. Christoph Hirche
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dawid Murawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zarah Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Soeren Kneif
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Hünerbein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Hünerbein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hirche, C., Murawa, D., Mohr, Z. et al. ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat 121, 373–378 (2010). https://doi.org/10.1007/s10549-010-0760-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-010-0760-z

Keywords

Search

Navigation