Evaluation of the benefit of using blue dye in addition to indocyanine green fluorescence for sentinel lymph node biopsy
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Evaluation of the benefit of using blue dye in addition to indocyanine green fluorescence for sentinel lymph node biopsy in patients with breast cancer Wenbin Guo1*, Li Zhang2, Jun Ji2, Wei Gao1, Jintao Liu1 and Meng Tong1
Abstract Background: Near infrared-guided indocyanine green (ICG) fluorescence has vast potential for guiding sentinel lymph node biopsy (SLNB) in patients with breast cancer. The purpose of this study was to evaluate any additional clinical benefit for SLNB when blue dye is used in combination with ICG. Methods: Between November of 2009 and September of 2013, 86 patients diagnosed with breast cancer were investigated by SLNB using a combination of patent blue and ICG. A lymph node was considered as the sentinel lymph node (SLN) when it was stained with blue dye and/or fluorescence. A levelIandIIaxillary dissection was performed for verification of axillary node status after the SLNB. Results: The SLN identification rate of SLN for ICG-patent blue combination was comparable to that for ICG alone (98.8% versus 93%; P = 0.054), but the false-negative rate was reduced from 12% (3/25) to 4% (1/25). Twenty-four patients had positive SLNs. In two of those patients, although there were SLNs identified by both tracers, the positive SLNs were identified by blue dye only. Conclusion: Although blue dye did not improve the identification rate significantly, there was a definite benefit in improving the false-negative rate. The use of a fluorescence method together with blue dye is an ideal method for hospitals that do not have access to conventional radiation-based detection methods. Keywords: Sentinel lymph node biopsy, Breast cancer, Indocyanine green, Fluorescence imaging, Blue dye
Background Axillary lymph node status has consistently been shown to be the most significant prognostic factor in patients with breast cancer [1-4]. The method of sentinel lymph node biopsy (SLNB) is now well accepted for evaluation of axillary node status. Large validated studies including the ALMANAC trials have shown that SLNB in patients with breast cancer is a safe, reliable technique that stages the axilla accurately [5,6]. SLNB has been performed using different techniques: injection of blue dye, radioactive colloid or the combination * Correspondence: [email protected] 1 The Breast Centre, Department of Surgery, Dalian Central Hospital, Dalian Medical University, 826, Xinan Road, Shahekou District, Dalian 116033, China Full list of author information is available at the end of the article
of both. Although high rates of sentinel lymph node (SLN) detection have been obtained with all of these methods, there is no general consensus about the optimal technique [7,8]. The average rate of SLN identification using blue dye or radioactive colloid is over 90%, but ranges from 65 to 98% [9]. Some surgeons use the blue dye method alone. Although the dye method has several benefits including ease of use, cost effectiveness and safety, it has been pointed out that the
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