Sentinel lymph node detection by means of indocyanine green using the Karl Storz VITOM(R) fluorescence camera: a comparison between primary sentinel lymph node biopsy versus sentinel lymph node biopsy after neoadjuvant chemotherapy

Purpose The usage of radioactive Technetium(99m) (Tc-99m) colloid for the purpose of sentinel lymph node biopsy (SLNB) in early breast cancer is considered the gold standard in Germany. However, new tracers, such as near-infrared (NIR) imaging agents like indocyanine green (ICG) could offer an alternative in future, as they overcome drawbacks associated with radioactive Technetium(99m) (Tc-99m) like limited availability, high costs and radioactivity exposure for both patients and surgeons. Methods In this double-arm retrospective study, we sought to establish the usefulness of indocyanine green as an alternative or an addition to the conventional Technetium(99m) (Tc-99m) in the identification of the SLN in early breast cancer. Results Among the 161 patients who underwent primary SLNB, 34 patients had at least 1 SLN with metastasis. Among these patients with SLN metastasis, 33 had the SLN detected by ICG; while 31 had the SLN detected by Tc-99m. The conventional Technetium(99m) radiotracer failed to detect 2 patients with metastasis in this Arm of the study. Among the 87 patients who underwent SLNB after NACT, 13 patients had at least 1 SLN with metastasis. Among these 13 patients with SLN metastasis, ICG and Tc-99m had detected the SLN among 12 patients, while 1 patient had been detected by ICG alone. Conclusions Our results show that ICG is as effective as the radioisotope for SLNB even among patients who have undergone NACT. This trial is registered with the German Clinical Trial Register, ID: DRKS00013606.

Automated summary

The study demonstrates that indocyanine green can be as effective as the radioisotope for SLNB in early breast cancer patients, even among those who have undergone NACT. This offers a potential alternative to overcome the limitations associated with radioactive Technetium(99m) colloid, such as limited availability, high costs, and radioactivity exposure.