Application of indocyanine green fluorescence imaging combined with methylene blue staining in sentinel lymph node biopsy of breast cancer

doi:10.3877/cma.j.issn.1674-3946.2024.05.008

Abstract

Abstract:

Objective

To investigate the feasibility of combined application of indocyanine green (ICG) and methylene blue (MB) in sentinel lymph node biopsy (SLNB) of early breast cancer.

Methods

Data of 415 patients who underwent SLNB and axillary lymph node dissection from January 2014 to September 2023 were retrospectively analyzed. They were divided into MB + ICG group (n=197) and MB group (n=218) according to different staining methods. SPSS 26.0 software was used for data analysis. The detection rate and false negative rate of SLNB were compared by χ² test, and Bonferroni correction was performed if necessary. P<0.05 was statistically significant.

Results

The detection rate of SLN in MB + ICG group was 96.9%, which was significantly higher than 89.7% in MB group (P<0.05). Similarly, the average SLN number per patient in the combined group was 3.0, which was significantly higher than 2.1 in the MB group (P<0.05). The false negative rates of the combined group and the MB group were 7.3% and 10.5%, respectively, with no significant difference (P=0.791).

Conclusion

ICG and MB combined in SLNB can detect SLN more effectively than MB alone.

Key words: Indocyanine Green Fluorescence Imaging, Methylene Blue Staining, Breast Cancer, Sentinel Lymph Node Biopsy

Jia Song, Bo Wang, Kailu Sun, Jiangfeng Shang, Danping Wu, Yi Zhao. Application of indocyanine green fluorescence imaging combined with methylene blue staining in sentinel lymph node biopsy of breast cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 498-501.

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References 16

［1］	姚宏伟,高加勒,张忠涛.不断推动中国腹腔镜直肠癌外科临床诊治规范化［J/CD］.中华普外科手术学杂志（电子版）,2022,16(01):1-4.
［2］	郑民华,马君俊,赵轩.中国腹腔镜直肠癌根治术式选择原则与规范化［J/CD］.中华普外科手术学杂志（电子版）,2022,16(01):5-8.
［3］	Hsieh YC，Guo KW，Wang MW，et al. A Novel Injection Protocol Using Voluven（R）-Assisted Indocyanine Green with Improved Near-Infrared Fluorescence Guidance in Breast Cancer Sentinel Lymph Node Mapping-A Translational Study［J］. Ann Surg Oncol,2023,30(13):8419-8427.
［4］	Hua B，Li Y，Yang X，et al. Short-term and long-term outcomes of indocyanine green for sentinel lymph node biopsy in early-stage breast cancer［J］. World J Surg Oncol，2022,20(1):253.
［5］	Liu M，Liu S，Zhao Q，et al. Using the Indocyanine Green（ICG）Lymphography to Screen Breast Cancer Patients at High Risk for Lymphedema［J］. Diagnostics（Basel），2022,12(4):983.
［6］	Ng S，Pitsinis V，Elseedawy EH，et al. Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index［J］. Eur Surg Res，2023,64(2):230-236.
［7］	Nguyen CL，Zhou M，Easwaralingam N，et al. Novel Dual Tracer Indocyanine Green and Radioisotope Versus Gold Standard Sentinel Lymph Node Biopsy in Breast Cancer: The greenorblue trial［J］. Ann Surg Oncol，2023,30(11):6520-6527.
［8］	Nguyen CL，Zhou M，Easwaralingam N，et al. ASO Visual Abstract: Novel Dual Tracer Indocyanine Green and Radioisotope Versus Gold Standard Sentinel Lymph Node Biopsy in Breast Cancer-The GREENORBLUE Trial［J］. Ann Surg Oncol，2023,30(11):6530-6531.
［9］	Ou C，Luo Y，He L，et al. Application of fluorescence endoscopy with methylene blue dye and indocyanine green dual-tracer method in sentinel lymph node biopsy for women with breast cancer［J］. Gland Surg，2023,12(6):780-790.
［10］	Pellini F，Bertoldi L，Deguidi G，et al. The use of indocyanine green as the only tracer for the identification of the sentinel lymph node in breast cancer: safety and feasibility［J］. Gland Surg，2022,11(7):1139-1147.
［11］	Soran A，Bengur FB，Rodriguez W，et al. Early Detection of Breast Cancer-Related Lymphedema: Accuracy of Indocyanine Green Lymphography Compared with Bioimpedance Spectroscopy and Subclinical Lymphedema Symptoms［J］. Lymphat Res Biol，2023,21(4):359-365.
［12］	Tokumoto H，Akita S，Nakamura R，et al. Investigation of the Association Between Breast Cancer-Related Lymphedema and the Side Effects of Taxane-Based Chemotherapy Using Indocyanine Green Lymphography［J］. Lymphat Res Biol，2022,20(6):612-617.
［13］	Wang P，Shuai J，Leng Z，et al. Meta-analysis of the application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy for breast cancer［J］. Photodiagnosis Photodyn Ther，2023,43:103742.
［14］	Wang ZH，Gang TR，Wu SS，et al. Single-port endoscopic-sentinel lymph node biopsy combined with indocyanine green and carbon nanoparticles in breast cancer［J］. Surg Endosc，2023,37(10):7591-7599.
［15］	Xiaoming L，Wei T，Yi'Nan J，et al. Application of combined preoperative indocyanine green lymphography and ultrasonography for low-pressure vein localization in secondary lymphedema surgery for breast cancer［J］. Asian J Surg,2024,47(1):289-295.
［16］	Yamamoto T，Yamamoto N. Indocyanine Green Lymphography for Evaluation of Breast Lymphedema Secondary to Breast Cancer Treatments［J］. J Reconstr Microsurg，2022,38(8):630-636.

组别	例数	年龄(岁，)	已绝经（例）	体重指数(kg/m²，)
MB	218	46.7±11.2	77	22.1±2.0
MB+ICG	197	45.3±10.9	63	23.0±2.3
t/χ²值		1.792	2.581	1.886
P值		0.368	0.471	0.420
组别	例数	ER阳性（例）	PR阳性（例）	HER-2阳性（例）
MB	218	144	134	20
MB+ICG	197	135	129	17
t/χ²值		2.110	1.976	1.826
P值		0.590	0.396	0.454

组别	例数	年龄(岁，)	已绝经（例）	体重指数(kg/m²，)
MB	218	46.7±11.2	77	22.1±2.0
MB+ICG	197	45.3±10.9	63	23.0±2.3
t/χ²值		1.792	2.581	1.886
P值		0.368	0.471	0.420
组别	例数	ER阳性（例）	PR阳性（例）	HER-2阳性（例）
MB	218	144	134	20
MB+ICG	197	135	129	17
t/χ²值		2.110	1.976	1.826
P值		0.590	0.396	0.454

类别	MB	MB+ICG	P值
行SLNB检测（例）	218	197
检测到SLN（例）	196	191
SLN的检出率(%)	89.7	96.9	0.004
每个患者检测到的SLN(范围)	2.1(1-4)	3.0(1-6)	0.011

类别	MB	MB+ICG	P值
行SLNB检测（例）	218	197
检测到SLN（例）	196	191
SLN的检出率(%)	89.7	96.9	0.004
每个患者检测到的SLN(范围)	2.1(1-4)	3.0(1-6)	0.011

组别	例数	实际有病人数+被判无病人数	实际有病而被判无病人数	假阴性率
MB+ICG	197	51	4	7.3
MB	218	51	6	10.5

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