Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer

Purpose: Near-infrared fluorescence imaging with indocyaninegreen (ICG) has the potential to improve sentinel lymph node(SLN) mapping in breast cancer. In this clinical trial, we comparedthe potential value of ICG combined with blue dye withthat of blue dye alone for detecting SLNs. Methods: Patients undergoingSLN biopsy (SLNB) between November 2010 and November2013 were included. Up to December 2011, SLNs weredetected by using patent blue (PB) alone, and since January2012, by using PB in combination with ICG. The patients weredivided into the following two groups: group A (ICG-PB; n=96)and group B (PB; n=73), and SLN detection parameters werecompared between the groups. All patients underwent level Iand II axillary dissections after SLNB. Results: In group A, theSLN detection rate was 96.9% (93/96), the accuracy of detectionwas 98.9% (92/93), and the false-negative rate (FNR) was3.4% (1/29). In group B, the SLN detection rate was 84.9%(62/73), the accuracy of detection was 96.8% (60/62), and theFNR was 11.1% (2/18). The ICG-PB group showed significantlysuperior results compared to the PB group for SLN detection(p=0.005) and a greatly improved FNR. Conclusion: The combinedfluorescence and blue dye-based tracer technique wassuperior to the use of blue dye alone for identifying SLNs, andfor predicting axillary lymph node status in patients with breastcancer; in addition, the combined technique had reduced falsenegativeresults.