Assessing the benefit of using indocyanine green in addition to methylene blue for breast cancer sentinel lymph node biopsy.

In recent years, indocyanine green (ICG) fluorescence has been widely used as a new tracer in sentinel lymph node biopsy (SLNB) for breast cancer. This self-controlled study identified the benefits in SLNB between methylene blue (MB) tracer alone and MB combined with ICG fluorescence imaging (MB + ICG) dual tracing modality in patients with breast cancer. One hundred seventy-nine SLNB with MB + ICG dual tracing in 178 cN0 breast cancer patients were enrolled, and their clinical data were analyzed. The results showed that the identification rate (IR) of sentinel lymph nodes (SLNs) by MB staining alone was 92% (165/179), the mean number of detected SLNs was 2.1 ± 1.2, the rate of ≥3 SLNs was 33% (55/165), and the number of positive (metastatic) lymph nodes was 40. The IR of SLN by MB + ICG dual tracing imaging was 93.9% (168/179), the mean number of detected SLNs was 3.8 ± 1.8, the rate of ≥3 SLNs was 70.8% (119/168), and the number of positive lymph nodes was 40. Compared to MB staining alone, because of the addition of ICG fluorescence imaging, SLN status changed from N0 to N1 or the number of positive SLNs increased in 9 patients, and there was an alteration of axillary management from SLNB to axillary lymph node dissection in 4 patients. Although MB + ICG dual tracing did not significantly improve the IR of SLNs, it increased the average number of SLNs, rate of ≥3 SLNs, number of positive SLNs. This may reduce the false negative rate of SLNB and lead to an alteration in axillary management.