Comparison of Indocyanine Green Fluorescence and Technetium-99m for Sentinel Lymph Node Detection in Breast Cancer: A Retrospective Single-Center Study.

Background/

Objectives

Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in early breast cancer. While technetium-99m (99mTc) radiocolloid is currently the standard tracer, indocyanine green (ICG) fluorescence represents a promising alternative. This study aimed to compare the detection rates of both methods in a dual-tracer setting.

Methods

A retrospective, single-center cohort study was conducted at the Department of Gynecology, Ahaus Hospital, Germany, between April 2024 and March 2025. Fifty-two patients with malignant breast tumors underwent SLNB using both ICG fluorescence and 99mTc radiocolloid.

Results

Combined tracer use achieved a 100% sentinel lymph node detection rate. ICG alone detected nodes in 49/52 patients (94.23%), while 99mTc achieved detection in 50/52 patients (96.15%). ICG identified all eight metastatic cases (100%), whereas 99mTc identified seven of eight (87.5%). In obese patients (BMI ≥ 30, n = 10), ICG achieved 100% detection versus 90% for 99mTc. The cost per application was 62.73 EUR for ICG versus approximately 250 EUR for 99mTc.

Conclusions

ICG fluorescence demonstrates comparable detection rates to 99mTc with advantages in cost-effectiveness, feasibility, and performance in obese patients. ICG represents a safe, radiation-free alternative for sentinel lymph node mapping in breast cancer surgery.