Indocyanine Green Compared to Technetium-99m in Sentinel Node Detection in Breast Cancer: A Single-center Retrospective Study

Introduction: Sentinel lymph node biopsy (SLNB) is a standard procedure in the surgical management of early-stage breast cancer. While the Tc99m radioisotope technique is the gold standard for SLNB, indocyanine green (ICG) fluorescence imaging has emerged as a potential alternative. Our study aimed to evaluate the concordance between ICG and Tc99m in detecting axillary sentinel lymph nodes (SLNs) in breast cancer patients.

Materials and Methods: We conducted a retrospective single-center study between January 2021 and October 2021. Patients with localized breast cancer and indication for axillary SLNB were included. Preoperative Tc99m lymphoscintigraphy and intraoperative ICG fluorescence imaging were performed. The primary outcome was the concordance rate between the two methods in detecting SLNs.

Results: Eleven patients with a total of 34 SLNs were included. The detection rate was 94.1%, with 32 SLNs detected by ICG and 23 by Tc99m. Concordance between the two methods was 67.6%. All discordant SLNs (26.5%) were ICG positive/Tc99m negative, including one micrometastatic SLN detected only by ICG. No complications related to ICG use were observed.

Conclusion: Our study suggests that ICG could be a promising alternative to Tc99m for SLNB in breast cancer, potentially offering higher sensitivity. However, larger prospective studies are needed to confirm these findings and establish standardized protocols for ICG use.