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Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer.

Tong M, Guo W, Gao W - J Breast Cancer (2014)

Bottom Line: The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups.The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR.The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Breast Center, Dalian Central Hospital of Dalian Medical University, Dalian, China.

ABSTRACT

Purpose: Near-infrared fluorescence imaging with indocyanine green (ICG) has the potential to improve sentinel lymph node (SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye with that of blue dye alone for detecting SLNs.

Methods: Patients undergoing SLN biopsy (SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected by using patent blue (PB) alone, and since January 2012, by using PB in combination with ICG. The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups. All patients underwent level I and II axillary dissections after SLNB.

Results: In group A, the SLN detection rate was 96.9% (93/96), the accuracy of detection was 98.9% (92/93), and the false-negative rate (FNR) was 3.4% (1/29). In group B, the SLN detection rate was 84.9% (62/73), the accuracy of detection was 96.8% (60/62), and the FNR was 11.1% (2/18). The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR.

Conclusion: The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.

No MeSH data available.


Related in: MedlinePlus

Near-infrared fluorescence imaging during sentinel lymph node (SLN) mapping. (A) The periareolar injection site and afferent lymphatic duct are clearly observed. (B) A skin incision made at the point where the fluorescence disappeared, and a strong fluorescence is seen clearly after incision. (C) Lymphatic flow in the axilla is identified. (D) A resected SLN with fluorescence imaging reconfirmed by photodynamic eye.
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Figure 1: Near-infrared fluorescence imaging during sentinel lymph node (SLN) mapping. (A) The periareolar injection site and afferent lymphatic duct are clearly observed. (B) A skin incision made at the point where the fluorescence disappeared, and a strong fluorescence is seen clearly after incision. (C) Lymphatic flow in the axilla is identified. (D) A resected SLN with fluorescence imaging reconfirmed by photodynamic eye.

Mentions: A 3-minute breast massage was performed following a subareolar injection of a 2.0-mL mixture containing ICG (10 mg) and PB (15 mg). Subsequent image acquisition was conducted by using a PDE (Hamamatsu Photonics, Hamamatsu, Japan) with the near-infrared light source provided by room fluorescent lighting (760 nm wavelength). The lymphatic transport of ICG was observed in real-time with fluorescence imaging for 5 to 10 minutes after the injection, by which time the ICG had generally reached the axillary lymph nodes. The fluorescence emitted by ICG was followed from the areola towards the axilla, and the observed subcutaneous lymphatic drainage pathway was marked on the skin at the point which the fluorescent signal disappeared. A skin incision was made at this point (Figure 1). All fluorescent and/or blue nodes were excised and regarded as SLNs.


Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer.

Tong M, Guo W, Gao W - J Breast Cancer (2014)

Near-infrared fluorescence imaging during sentinel lymph node (SLN) mapping. (A) The periareolar injection site and afferent lymphatic duct are clearly observed. (B) A skin incision made at the point where the fluorescence disappeared, and a strong fluorescence is seen clearly after incision. (C) Lymphatic flow in the axilla is identified. (D) A resected SLN with fluorescence imaging reconfirmed by photodynamic eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197355&req=5

Figure 1: Near-infrared fluorescence imaging during sentinel lymph node (SLN) mapping. (A) The periareolar injection site and afferent lymphatic duct are clearly observed. (B) A skin incision made at the point where the fluorescence disappeared, and a strong fluorescence is seen clearly after incision. (C) Lymphatic flow in the axilla is identified. (D) A resected SLN with fluorescence imaging reconfirmed by photodynamic eye.
Mentions: A 3-minute breast massage was performed following a subareolar injection of a 2.0-mL mixture containing ICG (10 mg) and PB (15 mg). Subsequent image acquisition was conducted by using a PDE (Hamamatsu Photonics, Hamamatsu, Japan) with the near-infrared light source provided by room fluorescent lighting (760 nm wavelength). The lymphatic transport of ICG was observed in real-time with fluorescence imaging for 5 to 10 minutes after the injection, by which time the ICG had generally reached the axillary lymph nodes. The fluorescence emitted by ICG was followed from the areola towards the axilla, and the observed subcutaneous lymphatic drainage pathway was marked on the skin at the point which the fluorescent signal disappeared. A skin incision was made at this point (Figure 1). All fluorescent and/or blue nodes were excised and regarded as SLNs.

Bottom Line: The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups.The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR.The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Breast Center, Dalian Central Hospital of Dalian Medical University, Dalian, China.

ABSTRACT

Purpose: Near-infrared fluorescence imaging with indocyanine green (ICG) has the potential to improve sentinel lymph node (SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye with that of blue dye alone for detecting SLNs.

Methods: Patients undergoing SLN biopsy (SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected by using patent blue (PB) alone, and since January 2012, by using PB in combination with ICG. The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups. All patients underwent level I and II axillary dissections after SLNB.

Results: In group A, the SLN detection rate was 96.9% (93/96), the accuracy of detection was 98.9% (92/93), and the false-negative rate (FNR) was 3.4% (1/29). In group B, the SLN detection rate was 84.9% (62/73), the accuracy of detection was 96.8% (60/62), and the FNR was 11.1% (2/18). The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR.

Conclusion: The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results.

No MeSH data available.


Related in: MedlinePlus