Breast Center, Department of Thyroid-Breast-Hernia Surgery, Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
World J Surg Oncol. 2022 Aug 9;20(1):253. doi: 10.1186/s12957-022-02719-7.
Indocyanine green (ICG) is becoming a frequently used sentinel lymph node (SLN) tracer of breast cancer in China. However, there is still a lack of data on its safety. We reported the clinical outcome of ICG as a tracer of SLN over a median 67-month follow-up period to evaluate its feasibility in clinically node-negative patients with breast cancer.
A total of 194 consecutive patients underwent sentinel lymph node biopsy (SLNB) with ICG, radioisotopes (RI) and methylene blue (MB), or with ICG and MB. The SLN mapping data by each tracer was recorded, and safety outcomes were analyzed through follow-up.
With the triad mapping (N = 44), the identification rate of SLN by ICG was 95.5%, slightly higher than that of MB (86.4%) and comparable with RI (95.5%) and combined methods (95.5%, 100%) (p = 0.068). Analysis of all candidates (N = 194) demonstrated that the identification rate of SLN by ICG or by ICG and MB was 99%, significantly higher than that by MB (92.8%) (p < 0.0001). No tracer-related allergic reaction and permanent skin staining of ICG were observed. Local disease progression was reported in 2 of the 194 patients at the ipsilateral axilla. After remedial axillary lymph node dissection, no disease progression was detected at follow-up.
ICG as an SLN tracer is more accurate than MB and comparable to the combined methods and has good clinical safety. ICG can be considered a useful supplement or suitable alternative to traditional tracers.
吲哚菁绿（ICG）在中国已成为乳腺癌前哨淋巴结（SLN）常用示踪剂，但有关其安全性的数据仍缺乏。我们报道了 ICG 作为 SLN 示踪剂的临床结果，其中位随访时间为 67 个月，旨在评估其在临床淋巴结阴性乳腺癌患者中的可行性。
共 194 例连续患者接受了吲哚菁绿（ICG）、放射性同位素（RI）和亚甲蓝（MB）、或 ICG 和 MB 联合的前哨淋巴结活检（SLNB）。记录每种示踪剂的 SLN 定位数据，并通过随访分析安全性结果。
三联法（N=44）中，ICG 识别 SLN 的准确率为 95.5%，略高于 MB（86.4%），与 RI（95.5%）和联合方法（95.5%、100%）相当（p=0.068）。对所有候选者（N=194）的分析表明，ICG 或 ICG 和 MB 识别 SLN 的准确率为 99%，明显高于 MB（92.8%）（p<0.0001）。未观察到示踪剂相关过敏反应和 ICG 的永久性皮肤染色。194 例患者中有 2 例同侧腋窝出现局部疾病进展。在补救性腋窝淋巴结清扫后，随访时未发现疾病进展。
ICG 作为 SLN 示踪剂比 MB 更准确，与联合方法相当，具有良好的临床安全性。ICG 可被视为传统示踪剂的有用补充或替代方法。
