Real-time In Situ Navigation System With Indocyanine Green Fluorescence For Sentinel Lymph Node Biopsy In Patients With Breast Cancer

Background: Indocylcyanine green(ICG)is a new tracer with near-infrared fluorescence imaging and has been used for positioning of sentinel lymph node biopsy in breast surgery.However,the fluorescent signal is invisible to the naked eye and it may limit the application of NIRF(Near Infrared Fluorescence Imaging System)in realtime navigation of sentinel lymph node biopsy in breast cancer.The purpose of this study is to introduce a new near infrared system which can project real-time imaging in the operative field,evaluate its effectiveness and safety,and evaluate the application value of combining methylene blue(MB)and the new near infrared system in SLNB.Methods: The sentinel lymph nodes were located by ICG combined with MB in 60 cases of breast cancer with negative lymph nodes.Two kinds of NIR systems designed by the University of Science and Technology of China(USTC)and the angiogram of Langfang Mingde Medical Biotechnology Co.,Ltd.were used as navigation AIDS to locate Sentinel lymph nodes(SLNs).The lymph nodes developed by fluorescence,the blue lymph nodes stained by MB and the lymph nodes suspected to be positive by palpation were all resected,which were regarded as SLNS for rapid frozen pathological biopsy.Results: The success rate of the two instruments was 95%(57/60).A total of 186 SLNs were located by ICG combined with MB,and 2 of them were pathologically confirmed to have no lymph node tissue.The SLN detection rate of MB combined with ICG was 100%(184/184),and the SLN detection rate of MB alone as tracer was 86.96%(160/184).The median SLNS detected by fluorescence imager combined with MB under direct vision was 3(1-8),significantly higher than that detected by MB alone(2(1-7),P<0.05).Conclusion: Fluorescence imager can effectively trace sentinel lymph nodes and project fluorescence signals in situ during the operation,providing a continuous surgical navigation system without changing the field of vision.Compared with the MDE system,it has no significant difference in detection rate and safety.The high detection rate of fluorescein imager navigation combined with MB tracing under direct vision suggests that this method may be a new dual tracer method to replace nuclides.