Evaluation of the efficacy of using indocyanine green associated with fluorescence in sentinel lymph node biopsy

Introduction: Sentinel lymph node biopsy is the established technique in the axillary staging of patients with early breast cancer without clinical axillary involvement. Three techniques are widely used globally for the detection of sentinel lymph nodes: patent blue; the radiopharmaceutical technetium 99 with the use of the gamma probe; and the combination of these two techniques. Objectives: To evaluate the sentinel lymph node detection rate with an innovative technique: indocyanine green associated with fluorescence in breast cancer patients, its comparison with the other methods (patent blue and combined patent blue + indocyanine green). Methods: Ninety-nine patients were subdivided into three arms with 33 patients, one arm was submitted to the sentinel lymph node technique using patent blue, the other indocyanine green, and the third a combination of the two dyes. Results: The accuracy rate in the identification of the sentinel lymph node was 78.8% with the use of patent blue, 93.9% with indocyanine green and 100% with patent blue + indocyanine green. The combined group identified mainly two sentinel nodes (48.5%); however, the other groups more commonly identified only one sentinel lymph node. The mean time of sentinel lymph node identification was 20.6 minutes among patients submitted to the traditional dye, 8.6 minutes in the indocyanine green arm and 10 minutes in the combination of the two methods (P<0.001). The mean surgery time was 69.4 minutes with patent blue, 55.1 minutes with indocyanine green and 69.4 minutes with the combination (P<0.001). Conclusions: The sentinel lymph node detection rate by fluorescence with the use of indocyanine green was considered effective. The comparison of the sentinel lymph node detection rate between the use of patent blue, indocyanine green and patent blue + indocyanine green (combined) revealed statistically significant differences (p=0.030), with the combined method being the most effective.