Discipline of Mastology, Department of Gynecology, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil.
Department of Gynecology and Mastology, Hospital de Esperança, Presidente Prudente, São Paulo, Brazil.
PLoS One. 2023 Oct 25;18(10):e0273886. doi: 10.1371/journal.pone.0273886. eCollection 2023.
Sentinel lymph node biopsy is the technique recommended for the axillary staging of patients with breast cancer in the initial stages without clinical axillary involvement. Three techniques are widely used globally to detect sentinel lymph nodes: patent blue, the radiopharmaceutical technetium 99 with gamma probe, and the combination of these two.
To evaluate the sentinel lymph node detection rate with an innovative technique: indocyanine green (ICG) associated with fluorescence in breast cancer patients, and compare it with patent blue and a combination of patent blue and indocyanine green.
99 patients were sequentially (not randomly) allocated into 3 arms with 33 patients submitted to sentinel lymph node techniques. One arm underwent patent blue dying, the other indocyanine green, and the third received a combination of both. The detection rates between arms were compared.
The detection rate in identifying the sentinel lymph node was 78.8% with patent blue, 93.9% with indocyanine green, and 100% with the combination. Indocyanine green identified two sentinel nodes in 48.5% of patients; the other groups more commonly had only one node identified. The mean time to sentinel lymph node identification was 20.6 ± 10.7 SD (standard deviation) minutes among patients submitted to the patent blue dye, 8.6 ± 6.6 minutes in the indocyanine green arm, and 10 ± 8.9 minutes in the combined group (P<0.001; Student's test). The mean surgery time was 69.4 ± 16.9; 55.1 ± 13.9; and 69.4 ± 19.3 minutes respectively (P<0.001; Student's test).
The sentinel lymph node detection rate by fluorescence using indocyanine green was 93.9%, considered adequate. The rates using patent blue, indocyanine green, and patent blue plus indocyanine green (combined) were significantly different, and the indocyanine green alone is also acceptable, since it has a good performance in sentinel lymph node identification and it can avoid tattooing, with a 100% sentinel lymph node detection rate when combined with patent blue.
前哨淋巴结活检是一种推荐的技术，用于无临床腋窝受累的早期乳腺癌患者的腋窝分期。全球广泛使用三种技术来检测前哨淋巴结：专利蓝，放射性核素锝 99 与伽马探针，以及这两种技术的结合。
评估一种创新技术——吲哚菁绿（ICG）联合荧光在乳腺癌患者中检测前哨淋巴结的检出率，并与专利蓝和专利蓝与吲哚菁绿联合检测进行比较。
99 例患者连续（非随机）分为 3 组，每组 33 例患者接受前哨淋巴结技术。一组行专利蓝染色，另一组行吲哚菁绿染色，第三组行两者联合。比较各组之间的检出率。
专利蓝的前哨淋巴结检出率为 78.8%，吲哚菁绿为 93.9%，两者联合为 100%。吲哚菁绿在 48.5%的患者中识别出两个前哨淋巴结，而其他组更常见的是只有一个淋巴结被识别。接受专利蓝染料的患者中，前哨淋巴结识别的平均时间为 20.6±10.7 标准差（SD）分钟，吲哚菁绿组为 8.6±6.6 分钟，联合组为 10±8.9 分钟（P<0.001；学生 t 检验）。平均手术时间分别为 69.4±16.9、55.1±13.9 和 69.4±19.3 分钟（P<0.001；学生 t 检验）。
使用吲哚菁绿荧光检测前哨淋巴结的检出率为 93.9%，认为是足够的。使用专利蓝、吲哚菁绿和专利蓝加吲哚菁绿（联合）的检出率有显著差异，而单独使用吲哚菁绿也可以接受，因为它在前哨淋巴结识别方面表现良好，并且可以避免纹身，与专利蓝联合使用时前哨淋巴结的检出率为 100%。
