Sentinel lymph node biopsy under guidance of fluorescent ındocyanin green: Initial experience
Fatih Aydoğan1, Akif Enes Arıkan2, Erman Aytaç2, Mehmet Velidedeoğlu2, Mehmet Halit Yılmaz3, Muhammet Sait Sager4, Varol Çelik1, Cihan Uras1
1Department of General Surgery, Breast Diseases Service, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
2Department of General Surgery, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
3Department of Radiology, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
4Department of Nuclear Medicine, İstanbul University, Cerrahpaşa Medical Faculty İstanbul, Turkey
Objective: Sentinel lymph node biopsy can be applied either via blue dye either radionuclide method or both in breast cancer. Fluorescent imaging with indocyanine green is a new defined method. This study evaluates the applicability of sentinel lymph node biopsy via fluorescent indocyanine green.
Material and Methods: For imaging, IC-VIEW (Pulsion Medical Systems AG, Munich, Germany) infrared visualization system was used. To visualize sentinel lymph nodes 2 ml of indocyanine green was injected. After injection, subcutaneous lymphatics were followed and sentinel lymph nodes were found with simultaneous imaging. Sentinel lymph nodes were excised under guidance of fluorescent light and excised lymph nodes were examined histopathologically. Patients in whose sentinel lymph node metastases were detected underwent to axillary dissection.
Results: Four patients with sentinel lymph node biopsy because of breast cancer was involved in the study. Sentinel lymph nodes were visualized with indocyanine green in all patients. Median number of excised sentinel lymph node number was 2 (2-3). Two patients with lymph node metastasis detected underwent to axillary dissection. No metastasis was detected in lymph nodes other than sentinel in patients with axillary dissection. There was no complication during and after operation due to method.
Conclusion: According to our limited experience, sentinel lymph node biopsy under guidance of fluorescent indocyanine green that has advantage of simultaneous visualization is technically feasible.
Keywords: Fluorescent light, indocyanine green, sentinel lymph node biopsy
Ethics committee approval was received for this study from the ethics committee of İstanbul University Cerrahpaşa Faculty of Medicine.
Written informed consent was obtained from patients who participated in this study.
Concept - F.A.; Design - V.C.; Supervision - C.U.; Funding - C.U.; Materials - F.A., E.A.; Data Collection and/or Processing - A.E.A., M.H.Y., M.S.S.; Analysis and/or Interpretation - E.A.; Literature Review - F.A.; Writer - A.E.A., F.A.; Critical Review - F.A., V.C., A.E.A.; Other - M.V.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.