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Axillary lymph node recurrence after sentinel lymph node biopsy performed using a combination of indocyanine green fluorescence and the blue dye method in early breast cancer

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A Letter to the Editor to this article was published on 12 April 2015

Abstract

Background

There is limited information on indocyanine green (ICG) fluorescence and blue dye for detecting sentinel lymph node (SLN) in early breast cancer. A retrospective study was conducted to assess the feasibility of an SLN biopsy using the combination of ICG fluorescence and the blue dye method.

Methods

Seven hundred and fourteen patients with clinically node-negative breast cancer were included in this study. They underwent SLN biopsy using a combination of ICG fluorescence and the blue dye method from March 2007 to February 2014. The ICG (a fluorescence-emitting source) and patent blue (the blue dye) were injected into the patients’ subareolar region. The removed lymph nodes that had ICG fluorescence and/or blue dye uptake were defined as SLNs. The results of the SLN biopsies and follow-up results of patients who underwent SLN biopsy alone were investigated.

Results

In 711 out of 714 patients, SLNs were identified by a combination of ICG fluorescence and the blue dye method (detection rate, 99.6 %). The average number of SLNs was 2.4 (range 1–7), and the average number of resected swollen para-SLNs was 0.4 (range 0–5). Ninety-nine patients with an SLN and/or para-SLN involvement during the intraoperative pathological diagnosis underwent axillary lymph node resection (ALND). In addition, two of three patients whose SLN was not identified also underwent ALND. In 46 of 101 patients with an ALND, non-SLN involvement was not found. Follow-up results were analyzed in 464 patients with invasive carcinoma excluding those with ductal carcinoma in situ (n = 148) and those who underwent ALND (n = 101). During the follow-up period (range 4.4–87.7 months; median, 38 months), two patients (0.4 %) developed axillary lymph node recurrence. They were successfully salvaged, and to date, no further locoregional recurrence has been observed.

Conclusions

A high rate of SLN detection and low rate of axillary lymph node recurrence were confirmed by an SLN biopsy using a combination of ICG fluorescence and the blue dye method. Therefore, it is suggested that this method may replace the combination of dye and radioisotope methods.

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Conflicts of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Breast Surgery, Kaizuka City Hospital, 3-10-20, Hori, Kaizuka, Osaka, 597-0015, Japan

    Tomoo Inoue, Toshio Nishi, Yoshiaki Nakano, Ayaka Nishimae & Hideo Inaji

  2. Department of Diagnostic Radiology, Kaizuka City Hospital, Kaizuka, Osaka, Japan

    Yuka Sawai

  3. Department of Pathology, Kaizuka City Hospital, Kaizuka, Osaka, Japan

    Masaru Yamasaki

Authors
  1. Tomoo Inoue
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  2. Toshio Nishi
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  3. Yoshiaki Nakano
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  4. Ayaka Nishimae
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  5. Yuka Sawai
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  6. Masaru Yamasaki
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  7. Hideo Inaji
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Corresponding author

Correspondence to Tomoo Inoue.

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Inoue, T., Nishi, T., Nakano, Y. et al. Axillary lymph node recurrence after sentinel lymph node biopsy performed using a combination of indocyanine green fluorescence and the blue dye method in early breast cancer. Breast Cancer 23, 295–300 (2016). https://doi.org/10.1007/s12282-014-0573-8

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  • DOI: https://doi.org/10.1007/s12282-014-0573-8

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