Oncological outcomes and locoregional recurrence after fluorescence guided surgery for axillary staging in early breast cancer: A single UK center experience

Abstract

Sentinel lymph node biopsy (SLNB) is an established standard technique for staging the axilla in clinically node-negative breast cancer patients. This study evaluates the efficacy of a dual tracer technique combining Indocyanine Green (ICG) fluorescence and blue dye for SLNB in early breast cancer patients at a single institution (Perth Royal Infirmary, Scotland). Over an eight-month period, 139 patients with clinically node-negative invasive breast cancer underwent SLNB, achieving a sentinel lymph node identification rate of 98.5%. Among the identified nodes, a node positivity rate of 19.7% was observed. With a median follow-up of 42 months, axillary recurrence was recorded in only 0.9% of patients, alongside local and distant recurrences of 1.8% and 5.5%, respectively. The findings suggest that the ICG and blue dye technique maintains a low axillary recurrence rate comparable to traditional methods, while also addressing logistical challenges posed by the COVID-19 pandemic. This technique offers a promising alternative to radioisotope-based methods and opens new possible routes for non-radioactive axillary staging techniques. Further long-term outcomes are anticipated as the use of ICG as a sole tracer is integrated into routine practice.