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Open Access 20.07.2023 | ASO Author Reflections

ASO Author Reflections: Indocyanine Green Fluorescence Sentinel Lymph Node Biopsy in Breast Cancer—An Alternative to Blue Dye?

verfasst von: Chu Luan Nguyen, MBBS, MMed, MPhil, Michael Zhou, BCom, Neshanth Easwaralingam, MBBS, MS, FRACS, Jue Li Seah, MBBS, MS, FRACS, Farhad Azimi, MBBS, MS, FRACS, Cindy Mak, MBBS, FRACS, Carlo Pulitano, MD, PhD, FRACS, Sanjay Kumar Warrier, MBBS, MS, FRACS

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2023

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Past

Sentinel lymph node (SLN) biopsy with blue dye (BD) and/or radioisotope (RI) has become standard of care in clinically node-negative early breast cancer since the tracers were introduced in the early 1990s. Fluorescence-guided SLN biopsy using indocyanine green (ICG), a green fluorophore dye, was introduced in 2005 for breast cancer in an attempt to overcome drawbacks of BD and RI.1 Following injection of ICG into the breast, a near-infrared camera allows for visualization of subcutaneous lymphatic flow and lymph nodes in real time for axillary dissection.2
There is no consensus on how ICG will complement or potentially replace traditional methods of SLN mapping. This is due to the technique’s infancy and quality of current available data mostly consisting of comparative cohort studies.3 There is a lack of data on a direct comparison between gold standard dual technique of BD-RI versus ICG combined with RI (ICG-RI).

Present

Our study compared 150 prospective patients with early breast cancer undergoing SLN biopsy using ICG-RI with 150 prior patients using BD-RI.4 The number of SLNs identified, rate of failed mapping, identification of metastatic SLNs, and adverse reactions between the two techniques were found to be equivalent. Cost-minimization analysis showed that ICG-RI cost an additional AU $197 per case in addition to the imaging system cost, which could be a significant limiting factor in the adoption of ICG technology.

Future

We found that novel tracer combination, ICG-RI, provided an effective and safe alternative to gold standard dual tracer. The proviso was the higher expense associated with ICG. Increased uptake of fluorescence technology in the future could potentially lower costs of the imaging system. The combination of ICG-RI could represent a transition phase with ICG used as a sole tracer in future. Future multicenter randomized controlled trials evaluating ICG as single or dual tracer are needed to provide definitive information for change in practice.

Acknowledgement

None.

Disclosure

None to declare.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Literatur
1.
Zurück zum Zitat Kitai T, Inomoto T, Miwa M, et al. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer. 2005;12(3):211–5.CrossRefPubMed Kitai T, Inomoto T, Miwa M, et al. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer. 2005;12(3):211–5.CrossRefPubMed
2.
Zurück zum Zitat Goonawardena J, Yong C, Law M. Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis. Am J Surg. 2020;220(3):665–76.CrossRefPubMed Goonawardena J, Yong C, Law M. Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis. Am J Surg. 2020;220(3):665–76.CrossRefPubMed
3.
Zurück zum Zitat Kedrzycki MS, Leiloglou M, Ashrafian H, et al. Meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery. Ann Surg Oncol 2020;28:3738-3748. Kedrzycki MS, Leiloglou M, Ashrafian H, et al. Meta-analysis comparing fluorescence imaging with radioisotope and blue dye-guided sentinel node identification for breast cancer surgery. Ann Surg Oncol 2020;28:3738-3748.
Metadaten
Titel
ASO Author Reflections: Indocyanine Green Fluorescence Sentinel Lymph Node Biopsy in Breast Cancer—An Alternative to Blue Dye?
verfasst von
Chu Luan Nguyen, MBBS, MMed, MPhil
Michael Zhou, BCom
Neshanth Easwaralingam, MBBS, MS, FRACS
Jue Li Seah, MBBS, MS, FRACS
Farhad Azimi, MBBS, MS, FRACS
Cindy Mak, MBBS, FRACS
Carlo Pulitano, MD, PhD, FRACS
Sanjay Kumar Warrier, MBBS, MS, FRACS
Publikationsdatum
20.07.2023
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2023
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13951-0

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