Ann Surg Treat Res.  2019 Jul;97(1):1-6. 10.4174/astr.2019.97.1.1.

Comparative study of indocyanine green combined with blue dye with methylene blue only and carbon nanoparticles only for sentinel lymph node biopsy in breast cancer

• Qin X
• Yang M
• Zheng X

• KMID: 2450983
• DOI: http://doi.org/10.4174/astr.2019.97.1.1

Abstract

PURPOSE
The combination of indocyanine green and methylene blue (ICG + MB) was reported to be an efficient tracer method in sentinel lymph node biopsy (SLNB). However, whether this method is superior to MB only or carbon nanoparticles (CN) is controversial. This study was to evaluate the efficacy of the three methods in SLNB for breast cancer, and to analyze its influencing factors.
METHODS
One hundred eighty patients with early breast cancer were recruited and randomly divided into 3 groups. Each group comprising of 60 patients with SLNB using ICG + MB, MB, and CN, respectively. Then the 3 groups were compared in detection rate, mean number of SLNs, and the detection rates and number of metastatic sentinel lymph nodes (SLNs).
RESULTS
The detection rate of SLNs was 100% (60 of 60) in ICG + MB group, 96.7% (58 of 60), and 98.3% (59 of 60) in MB and CN group, respectively, with no significant difference (P = 0.362). Totally, 204 SLNs (mean ± standard deviation [SD] [range], 3.4 ± 1.4 [2-8]) were detected in ICG + MB group, 102 (1.7 ± 0.7 [0-3]) and 145 (2.4 ± 0.7 [0-6]) in MB and CN group, indicating significant difference (P < 0.001). The detection rate of metastatic SLN was 23.3% (14 of 60) in ICG + MB group, which was higher than 18.3% (11 of 60) and 20% (11 of 60) in MB and CN group, respectively, but showed no statistical significance (P = 0.788).
CONCLUSION
ICG + MB method was superior to MB only and CN only methods in the mean number of SLNs, thus predicting axillary lymph node metastasis more accurately. Therefore, in areas where the standard method is not available, ICG + MB may be more suitable as an alternative tracer for SLNB.

Keyword

Carbon nanoparticles; Indocyanine green; Methylene blue; Sentinel lymph node biopsy

MeSH Terms

Breast Neoplasms*
Breast*
Carbon*
Humans
Indocyanine Green*
Lymph Nodes
Methods
Methylene Blue*
Nanoparticles*
Neoplasm Metastasis
Sentinel Lymph Node Biopsy*
Carbon
Indocyanine Green
Methylene Blue

Figure

• 

  Fig. 1 Sentinel lymph node biopsy using ICG + MB method. (A) Two streams of fluorescent dermal lymphatic vessels and 2 fluorescent nodes were clearly observed by photodynamic eye camera. (B) The fluorescent lymphatic vessels and SLN flow were marked on the skin and an incision was made upon SLN region. (C) Three nodes and 1 lymphatic vessel link were removed. Only 1 was blue-stained. (D) All SLNs and the lymphatic vessels were fluorescent under the photodynamic eye camera. The result: 1 was ICG+/MB+ and 2 SLNs were ICG+/MB−. ICG, indocyanine green; MB, methylene blue; SLN, sentinel lymph node.

• 

  Fig. 2 Sentinel lymph node biopsy using MB and CN, respectively. (A) One blue-stained lymph node was detected in MB group. (B) One black-stained lymph node was detected in CN group. MB, methylene blue; CN, carbon nanoparticles.

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