Clinical Study Of Indocyanine Green Combined With Blue Dye Double Tracer Mode Under Fluorescence Endoscopy In Sentinel Lymph Node Biopsy Of Early Breast Cancer

PurposeTo investigate the efficacy and safety of indocyanine green combined with blue dye double tracer mode under fluorescence endoscopy in sentinel lymph node biopsy of early breast cancer.MethodsBreast cancer patients who were admitted to our department and confirmed to be eligible for this study from April 2021 to August 2022 were selected.Sentinel lymph node biopsy was performed under fluorescence endoscopy using indocyanine green combined with blue dye as tracer.The detection of sentinel lymph nodes(SLNs)and metastatic SLNs were observed under different exploration modes,including indocyanine green imaging,blue dye imaging and indocyanine green combined with blue dye imaging.The identification rate and median of SLNs and metastatic SLNs were compared among the three modes.The efficacy of lymph node tracing and the accuracy of detecting metastatic sentinel lymph nodes were evaluated.ResultsA total of 610 sentinel lymph nodes were detected in 166 patients.Sentinel lymph node metastasis was detected in 48 patients and 95 metastatic sentinel lymph nodes were found.Axillary lymph node dissection was subsequently performed in theses patients.The mean operation time of endoscopic sentinel lymph node biopsy(SLNB)was 34.32±14.75 minutes.All patients had no adverse reactions such as poor wound healing and tracer allergy after endoscopic sentinel lymph node biopsy.The identification rate of sentinel lymph nodes in indocyanine green group(94.6%)and indocyanine green combined with blue dye group(98.2%)were higher than that in blue dye group(82.5%)(P<0.05).The visualization rate of sentinel lymph nodes in the indocyanine green group(91.5%)and indocyanine green combined with blue dye group(95.7%)were higher than that in the blue dye group(50.2%)(P<0.05).The visualization rate of sentinel lymph nodes in the indocyanine green combined with blue dye group(95.7%)was higher than that in the indocyanine green group(91.5%)(P<0.05).The average number of sentinel lymph nodes detected in the indocyanine green group(3.36±1.82)and indocyanine green combined with blue dye group(3.52±1.72)were higher than that in the blue dye group(1.95±1.68)(P<0.05).The average number of sentinel lymph nodes detected in the indocyanine green combined with blue dye group(3.52± 1.72)was higher than that in the indocyanine green group(3.36±1.82)(P<0.05).The identification rates of metastatic sentinel lymph nodes by indocyanine green,blue dye and indocyanine green combined with blue dye were 75.0%,72.9%and 87.5%,respectively.There was no significant difference in the identification rate of metastatic SLN among the three modes(P=0.171).The visualization rate of metastatic sentinel lymph nodes in the ICG combined with blue dye double tracer group(72.7%)was higher than that in the blue dye group(51.6%)(P=0.003).The average number of metastatic sentinel lymph nodes detected in the indocyanine green combined with blue dye double tracer group(1.44±1.03)was higher than that in the indocyanine green group(1.13±1.00)(P<0.05).The average number of metastatic sentinel lymph nodes detected in the indocyanine green combined with blue dye double tracer group(1.44±1.03)was higher than that in the blue dye group(1.02±0.89)(P<0.05).There was no significant difference in the average number of metastatic sentinel lymph nodes detected between the indocyanine green group(1.13± 1.00)and the blue dye group(1.02±0.89)(P>0.05).The identification rate of sentinel lymph nodes(98.2%vs 94.6%)and the visualization rate of metastatic sentinel lymph nodes(72.7%vs 56.9%)had no significant difference between indocyanine green combined with blue dye group and indocyanine green group.ConclusionCompared with blue dye staining and ICG staining alone,ICG combined with blue dye double tracer mode has a higher identification rate of sentinel lymph nodes and a larger number of lymph nodes detected in fluorescence endoscopic sentinel lymph node biopsy of early breast cancer.In addition,more metastatic sentinel lymph nodes can be detected and the probability of false negative results can be reduced.Indocyanine green combined with blue dye double tracer mode under fluorescence endoscopy is an effective method to guide sentinel lymph node biopsy in early breast cancer.