Sentinel lymph node detection by means of indocyanine green using the Karl Storz VITOM® fluorescence camera: a comparison between primary sentinel lymph node biopsy versus sentinel lymph node biopsy after neoadjuvant chemotherapy

• Published in: Journal of cancer research and clinical oncology Vol. 147; no. 6; pp. 1813 - 1823
• Main Authors: Staubach, Petronilla, Scharl, Anton, Ignatov, Atanas, Ortmann, Olaf, Inwald, Elisabeth C., Hildebrandt, Thomas, Gerken, Michael, Klinkhammer-Schalke, Monika, Scharl, Sophia, Papathemelis, Thomas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2021; Springer Nature B.V
• Subjects: Biopsy; Breast cancer; Cancer Research; Chemotherapy; DRKS; DRKS00013606; Hematology; Internal Medicine; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Metastases; Metastasis; Oncology; Original Article – Clinical Oncology; Radioactivity; Radioisotopes; Neoadjuvant therapy; Sentinel biopsy; Breast cancer; Indocyanine green
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-020-03461-x

Purpose
The usage of radioactive Technetium
99m
(Tc
99m
) colloid for the purpose of sentinel lymph node biopsy (SLNB) in early breast cancer is considered the gold standard in Germany. However, new tracers, such as near-infrared (NIR) imaging agents like indocyanine green (ICG) could offer an alternative in future, as they overcome drawbacks associated with radioactive Technetium
99m
(Tc
99m
) like limited availability, high costs and radioactivity exposure for both patients and surgeons.
Methods
In this double-arm retrospective study, we sought to establish the usefulness of indocyanine green as an alternative or an addition to the conventional Technetium
99m
(Tc
99m
) in the identification of the SLN in early breast cancer.
Results
Among the 161 patients who underwent primary SLNB, 34 patients had at least 1 SLN with metastasis. Among these patients with SLN metastasis, 33 had the SLN detected by ICG; while 31 had the SLN detected by Tc
99m
. The conventional Technetium
99m
radiotracer failed to detect 2 patients with metastasis in this Arm of the study. Among the 87 patients who underwent SLNB after NACT, 13 patients had at least 1 SLN with metastasis. Among these 13 patients with SLN metastasis, ICG and Tc
99m
had detected the SLN among 12 patients, while 1 patient had been detected by ICG alone.
Conclusions
Our results show that ICG is as effective as the radioisotope for SLNB even among patients who have undergone NACT. This trial is registered with the German Clinical Trial Register, ID: DRKS00013606.