Sensitivity of Indocyanine Green Fluorescence Imaging System for Sentinel Lymph Node Biopsies in Early Breast Cancer Patients

Abstract

Background: Management in breast cancer is heading towards less invasive approaches with high survival and low recurrence rates. Axillary dissection (ALND) has a high morbidity on breast cancer patients; on the other hand, sentinel LN (SLN) biopsy overcomes such morbidity with comparable survival and recurrence rates. A lot of substances used as tracers for SLN, however some of them still have several drawbacks. Indocyanine green (ICG) is one of those tracers that’s recently used in SLN mapping.Patients and Methods: 40 patients with early breast cancer presented at breast surgery unit at Ain Shams University hospitals from June 2022 till June 2023 underwent SLN detection using indocyanine green (ICG) followed by axillary LN dissection (ALND) if the sentinel lymph node was positive for metastatic disease. Outcome: In this study, we aim to assess diagnostic accuracy of indocyanine green dye (ICG) in SLN biopsy in patients with early breast cancer.Results: Mean age of our participants was 50.48 ± 9.71. ICG sentinel lymph node biopsy was negative in 27 patients. The ICG dye was capable of detecting the positive lymph node metastasis in 13 patients with detection rate, sensitivity, specificity, accuracy and positive & negative predictive values of 100% based on the total number of patients (no=40). Conclusion: The ICG guided SLNB is a feasible, easy and cost-effective method for identification of sentinel lymph nodes. It is also considered highly sensitive, specific technique with high detection rate of SNs and transcutaneous identification of lymphatic flow pathways with high safety and with no side effects from ICG. This technique has a great potential to be an alternative method for the traditional SN biopsy using the radioactive agents or the blue dyes.