Comparative Study Of Indocyanine Green Combined With Methylene Blue With Methylene Blue Only For Sentinel Lymph Node Biopsy In Breast Cancer

BACKGROUND & OBJECTIVE: Indocyanine green(ICG)has been used as a new tracer in sentinel lymph node biopsy(SLNB)for breast cancer recently.In addition,it has been reported that it’s combined with blue dye method(ICG + MB)has high application value in SLNB.However,whether ICG+MB is superior to MB is still controversial.This study explored whether ICG can be used as a new tracer and whether its tracing effect is not inferior to MB.Besides,the two groups were compared in detection rate,mean number of SLNs and the detection rates and number of metastatic SLNs.Furthermore,we analyze the factors that affect the detection rate,and evaluate safety of the methods.Materials and methods: From October 2016 to December 2017,180 patients with early breast cancer were recruited and randomly divided into 2 groups.Each group comprising of 60 patients had SLNB using ICG+MB and MB.Then the detection rate,mean number of SLNs and the detection of metastatic SLNs were compared beside in ICG+MB group and between the two groups.Besides that,we analyze the factors that affect the detection rate,and evaluate safety of the methods.Results: In ICG + MB group,preoperative SLN localization rate was 95%(57/60).The detection rate of fluorescent SLN(100%)was higher than that of blue SLN(90%)(p <0.05)。Mean fluorescent SLNs was 3.3 and was higher than 1.9 blue SLNs.The detection rate of SLNs was 100%(60/60)in ICG+MB group,96.7%(58/60)in MB group,respectively,(p>0.05).Totally 204 SLNs [median3.4±1.4] were detected in ICG+MB group,102 [median1.7±0.7] in MB group,(p<0.05).The detection rate of metastatic SLN was 18.3%(11/60)in ICG + MB group,which was higher than 13.3%(8/60)in MB group,but there was no statistical significance(p >0.05).Age,BMI and other factors had no effect on the detection rate,and no serious adverse reactions were observed。Conclusions: ICG can be used as a safe and effective tracer for SLNB,and helped the surgeon locate the SLN,and its application value is not inferior to MB.ICG+MB is superior to MB in detection number,which makes it conform to the rule of lower false negative rate,thus can better reflect the true situation of axillary lymph nodes.Therefore,it is more suitable for sentinel lymph node biopsy as a safe tracing method.