Indocyanine green is a safe and effective alternative to radioisotope in breast cancer sentinel lymph node biopsy regardless of patient body mass index

Introduction: A recent meta-analysis [1] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI). Materials and Methods: All consecutive patients undergoing sentinel lymph node biopsies (SLNB) for early breast cancer in NHS Tayside were included in a prospective audit of surgical and pathology findings. All patients included in the study received dual injection of patent blue dye and ICG. Approval was obtained from the local Caldicott guardian for collection and use of personal data. Results: Of 239 cases, all were female patients of mean age 62 years (range 27-93). In 4.2% (10/239) of cases neither blue dye nor ICG was present in the axilla. Of the remaining 229 SLNB cases in this series, surgeons documented retrieval of 451 nodes, with a mean surgical nodal count per case of 1.97 (range 1-5) and pathological nodal count of 2.15 (range 0-7). 83 cases were performed in patients with BMI 30-39.9 and 21 cases with BMI>40, with nodal detection rates of 96.4% (80/83) and 95.2% (20/21) respectively in these groups of patients. 20% (48/229) of cases had nodal metastases on histopathology. Conclusions: This is a large single centre study which demonstrates the safety and accuracy of the combined ICG and blue dye technique for SLNB in breast cancer. This is represented by nodal detection rates and node positivity rates which are comparable to previous multicentre studies of standard SLNB regardless of BMI.