Hartmann Steffi, Plonus Meri-Liis, Schultek Gesche, Stubert Johannes, Gerber Bernd, Reimer Toralf
Universitätsfrauenklinik und Poliklinik, Klinikum Südstadt, Rostock, Germany.
Diagnostische und interventionelle Radiologie, Klinikum Südstadt, Rostock, Germany.
Geburtshilfe Frauenheilkd. 2024 Nov 12;85(6):631-638. doi: 10.1055/a-2436-1699. eCollection 2025 Jun.
Axillary sentinel lymph node excision (SLNE) in breast cancer patients with clinically node-negative disease may be carried out using different tracers. The standard tracer is technetium colloid ( Tc). Indocyanine green (ICG) can be used as an alternative. This study aimed to evaluate the clinical usefulness of this fluorescent dye in a standardized setting.
A prospective, single-center cohort study carried out at the University Gynecological Hospital of Rostock from September 2023 to May 2024 carried out sentinel lymph node marking using only ICG in patients with breast malignancies. The ICG injection was administered immediately after the induction of anesthesia. Detection of the sentinel lymph node (SLN) was done using a laparoscopy system suitable for ICG. The aim was to determine the detection rate (DR) for SLNs marked exclusively using ICG and to record any complications. The costs of using ICG to mark SLNs were compared with those for Tc marking.
During the study period, contraindications against marking with ICG were ascertained for five (3.8%) of 132 patients with planned SLNE. A total of 100 SLNEs were carried out after ICG marking in patients who met the inclusion criteria in the context of the study. A median of two SLNs were resected. The detection rate (DR) for SLNs was 98.0%. SLNs were identified in all obese patients. No serious systemic side effects occurred following ICG injection. Transient skin discoloration in the area around the injection site were observed in eight patients. The direct cost of ICG marking was 62.73 Euros, which was 170.36 Euros lower than the cost of Tc marking.
The detection rate of axillary SLNs marked using ICG is high and the method is cost-effective, has few side effects and can also be used in obese patients. Contraindications against the administration of ICG are rare. Marking with ICG is a good alternative to the Tc method and offers advantages in terms of costs, logistics, no exposure to radiation, and patient comfort.
对于临床检查淋巴结阴性的乳腺癌患者，腋窝前哨淋巴结切除（SLNE）可使用不同的示踪剂。标准示踪剂是锝胶体（Tc）。吲哚菁绿（ICG）可作为替代。本研究旨在评估这种荧光染料在标准化环境中的临床实用性。
2023年9月至2024年5月在罗斯托克大学妇科医院进行了一项前瞻性单中心队列研究，对乳腺恶性肿瘤患者仅使用ICG进行前哨淋巴结标记。ICG注射在麻醉诱导后立即进行。使用适用于ICG的腹腔镜系统检测前哨淋巴结（SLN）。目的是确定仅使用ICG标记的SLN的检测率（DR）并记录任何并发症。将使用ICG标记SLN的成本与使用Tc标记的成本进行比较。
在研究期间，132例计划进行SLNE的患者中有5例（3.8%）确定存在ICG标记的禁忌证。在研究范围内符合纳入标准的患者中，ICG标记后共进行了100例SLNE。切除的SLN中位数为两个。SLN的检测率（DR）为98.0%。在所有肥胖患者中均识别出SLN。ICG注射后未发生严重的全身副作用。8例患者观察到注射部位周围区域出现短暂皮肤变色。ICG标记的直接成本为62.73欧元，比Tc标记的成本低170.36欧元。
使用ICG标记腋窝SLN的检测率高，该方法具有成本效益，副作用少，也可用于肥胖患者。ICG给药的禁忌证很少见。用ICG标记是Tc方法的良好替代方案，在成本、后勤、无辐射暴露和患者舒适度方面具有优势。
