Abstract
Background
Indocyanine green (ICG) fluorescence navigation is a useful option in sentinel node biopsy (SNB) for breast cancer. However, several technical difficulties still exist. Since the sentinel node (SN) cannot be recognized over the skin, subcutaneous lymphatic vessels (LVs) must be carefully dissected without injury. In addition, the dissecting procedures are often interrupted by turning off the operating light during fluorescence observation. In this report, we introduce a new approach using the axillary compression technique to overcome these problems.
Materials and methods
In the original procedure of the ICG fluorescence method, the subcutaneous lymphatic drainage pathway from the breast to the axilla was observed in fluorescence images, but no signal could be obtained in the axilla. When the axillary skin was compressed against the chest wall using a plastic device, the signals from the deeper lymphatic structures could be observed. By tracing the compression-inducible fluorescence signal towards the axilla, transcutaneous detection and direct approach to the SN were achieved. The benefit of this approach is that there is no risk of injury of LVs, and the procedures are interrupted less frequently by fluorescence observation. The axillary compression technique was used in 50 patients with early breast cancer.
Results
SNs were successfully removed in all patients. Transcutaneous detection and direct approach were possible in 47 patients. This approach was also effective in obese patients.
Conclusions
Axillary compression technique is a simple way to facilitate the surgical procedures of ICG fluorescence-navigated SNB for breast cancer.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Eng J Med. 2003;349:546–53.
Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costanino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from NSABP B-32 randomized phase 3 trial. Lancet Oncol. 2010;11:927–33.
Mansel RE, Fallowfield J, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609.
Zavagno G, De Salvo GL, Scalco G, Bozza F, Barutta L, Del Bianco P, et al. 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. 2008;247:207–13.
Kitai T, Inomoto T, Shikayama T, Miwa M. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer. 2005;12:211–5.
Yamazaki TagayaN, Nakagawa R, Abe A, Hamada K, Kubota K, et al. Intraoperative identification of sentinel lymph nodes by near infrared fluorescence imaging in patients with breast cancer. Am J Surg. 2008;195:850–3.
Hirche C, Murawa D, Mohr Z, Kneif S, Hunerbein M. ICG fluorescence-guided sentinel biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat. 2010;121:373–8.
Troyan SL, Kianzad V, Gibbs-Strauss SL, Gioux S, Matsui A, Oketokoun R, et al. The FLARE intraoperative near-infrared fluorescence imaging system: a first in human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol. 2009;18:2943–52.
Hojo T, Nagao T, Kikuyama M, Akashi S, Kinoshita T. Evaluation of sentinel node biopsy by combined fluorescence and dye method and lymph flow for breast cancer. Breast. 2010;19:210–3.
Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol. 1978;23:159–63.
Yoshiya I. Spectrophotometric monitoring of arterial oxygen saturation in the finger tip. Med Biol Exp Comp. 1980;18:27–32.
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. 1999;44:2049–61.
Wilson BC. Optical properties of tissues. In: Encyclopedia of human biology, vol. 5. St. Louis: Academic Press; 1991. p. 587–97.
Sevick EM, Chance B, Leigh J, Nioka S, Maris M. Quantitation of time-and frequency-resolved optical spectra for the determination of tissue oxygenation. Anal Biochem. 1991;195:330–51.
Kitai T, Beauvoit B, Chance B. Optical determination of fatty change of the graft liver with near-infrared time-resolved spectroscopy. Transplantation. 1996;62:642–7.
Beauvoit B, Chance B. Time resolved spectroscopy of mitochondria, cells and tissues under normal and pathological condition. Moll Cell Biochem. 1998;184:445–55.
Kitai T. Bio-optical aspects in indocyanine green fluorescence for sentinel node biopsy in breast cancer. In: Toi M, Winer EP, editors. Local and systemic management of primary breast cancers. Kyoto: Kyoto University Press, Melbourne: Trans pacific Press; 2010. p. 36–44.
Chagpar AB, Scoggins CR, Martin RC II, Carlson DJ, Laidley AL, El-Eid SE, et al. Are 3 sentinel nodes sufficient? Arch Surg. 2007;142:456–9.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kitai, T., Kawashima, M. Transcutaneous detection and direct approach to the sentinel node using axillary compression technique in ICG fluorescence-navigated sentinel node biopsy for breast cancer. Breast Cancer 19, 343–348 (2012). https://doi.org/10.1007/s12282-011-0286-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12282-011-0286-1