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Evaluation of the Clinical Utility of the ICG Fluorescence Method Compared with the Radioisotope Method for Sentinel Lymph Node Biopsy in Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study compared the clinical utility of indocyanine green (ICG) fluorescence and radioisotope (RI) for sentinel lymph node (SLN) detection in breast cancer.

Methods

Women with node-negative breast cancer underwent SLN biopsy using ICG fluorescence and RI. The primary end point was the sensitivity of ICG fluorescence compared with RI in the patients with tumor-positive SLNs. Secondary end points included detection rates for SLN, the additive effect of ICG fluorescence to RI, signature of positive SLNs according to tier, and adverse events related to ICG administration.

Results

A total of 847 women with clinical node-negative breast cancer underwent SLN biopsy, and 821 patients were included in the per-protocol analysis. SLN mapping was performed using ICG fluorescence and RI. The overall detection of SLNs using ICG fluorescence was identical to RI (97.2 vs. 97.0 %, P = 0.88), and the combination of both methods achieved a significant improvement compared with RI alone (99.8 vs. 97.0 %, P < 0.001). The detection rate for tumor-positive SLN was 93.3 % for ICG fluorescence and 90.0 % for RI, and the sensitivity of the ICG fluorescence method was 95.7 % (95 % CI 91.3–98.3, P = 0.11). The additional use of ICG significantly improved positive SLN detection for RI (97.2 vs. 90.0 %, P < 0.001). There were no serious adverse events related to hypersensitivity to ICG.

Conclusions

The ICG fluorescence method may be an acceptable alternative to SLN detection using RI in breast cancer.

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Acknowledgment

This work was supported by research funding from Hamamatsu Photonics. The authors thank Akira Shimizu and Masahiro Takada for scientific advice and the staff of Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, for their valuable help.

Disclosure

T.S. received honoraria from Hamamatsu Photonics. The other authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Kansai Medical University, Hirakata, Japan

    Tomoharu Sugie MD, PhD

  2. National Cancer Center Hospital, Tokyo, Japan

    Takayuki Kinoshita MD, PhD

  3. National Hospital Organization Osaka National Hospital, Osaka, Japan

    Norikazu Masuda MD, PhD

  4. Department of Breast Surgery Oncology, Showa University School of Medicine, Tokyo, Japan

    Terumasa Sawada MD, PhD

  5. Tazuke-Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan

    Akira Yamauchi MD, PhD

  6. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Katsumasa Kuroi MD, PhD

  7. Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Tetsuya Taguchi MD, PhD

  8. Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Hiroko Bando MD, PhD

  9. Tenri Hospital, Tenri, Japan

    Hiroyasu Yamashiro MD, PhD

  10. Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    Tecchuu Lee MD, PhD

  11. Kyoto Breast Center Sawai Memorial Clinic, Kyoto, Japan

    Nobuhiko Shinkura MD, PhD

  12. Kobe City Medical Center General Hospital, Kobe, Japan

    Hironori Kato MD, PhD

  13. Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan

    Takafumi Ikeda PhD & Hanae Ueyama PhD

  14. Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan

    Kenichi Yoshimura PhD

  15. Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Masakazu Toi MD, PhD

Authors
  1. Tomoharu Sugie MD, PhD
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  2. Takayuki Kinoshita MD, PhD
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  3. Norikazu Masuda MD, PhD
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  4. Terumasa Sawada MD, PhD
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  5. Akira Yamauchi MD, PhD
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  6. Katsumasa Kuroi MD, PhD
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  7. Tetsuya Taguchi MD, PhD
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  8. Hiroko Bando MD, PhD
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  9. Hiroyasu Yamashiro MD, PhD
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  10. Tecchuu Lee MD, PhD
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  11. Nobuhiko Shinkura MD, PhD
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  12. Hironori Kato MD, PhD
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  13. Takafumi Ikeda PhD
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  14. Kenichi Yoshimura PhD
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  15. Hanae Ueyama PhD
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  16. Masakazu Toi MD, PhD
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Corresponding author

Correspondence to Tomoharu Sugie MD, PhD.

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Sugie, T., Kinoshita, T., Masuda, N. et al. Evaluation of the Clinical Utility of the ICG Fluorescence Method Compared with the Radioisotope Method for Sentinel Lymph Node Biopsy in Breast Cancer. Ann Surg Oncol 23, 44–50 (2016). https://doi.org/10.1245/s10434-015-4809-4

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  • DOI: https://doi.org/10.1245/s10434-015-4809-4

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