Comparative efficacy of indocyanine green and Tc-99m for sentinel lymph node biopsy in breast cancer: Upfront surgery and post-neoadjuvant chemotherapy

IF 3.5 3区医学 Q1 SURGERY

Asian Journal of Surgery Pub Date : 2025-05-01 DOI:10.1016/j.asjsur.2025.01.045

Tanakorn Tarapongpun , Hung-Wen Lai , Chiung-Ying Liao , Shih-Lung Lin , Hsin-I Huang , Shou-Tung Chen , Dar-Ren Chen

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引用次数: 0

Abstract

Background

This retrospective study aimed to compare the sensitivity of sentinel lymph node (SLN) detection using indocyanine green (ICG), Technetium-99 (Tc-99m), and combined technique (ICG + Tc-99m) in clinical node-negative early-stage breast cancer patients, both in upfront surgery and post-neoadjuvant chemotherapy (NAC) settings.

Method

Breast cancer patients who underwent breast surgery with SLN biopsy from December 2021 to May 2024 were enrolled. Both ICG and Tc-99m were used in combination during the SLN biopsy. The primary outcome was the SLN detection rate (per case) and nodal detection rate (per node) compared between ICG, Tc-99m, and combined technique.

Results

176 patients (128 upfront surgery, 48 post-NAC) were analyzed and a total of 326 SLNs were identified. The SLN detection rate was not different between ICG and Tc-99m in upfront surgery (96.1 % vs. 95.3 %, P = 0.65) and post-NAC (89.6 % vs. 85.4 %, P = 0.41). The mean number of identified SLNs was higher with ICG compared to Tc-99m (1.6 ± 1.0 vs. 1.4 ± 0.9, P < 0.001). ICG exhibited a higher overall nodal detection rate than Tc-99m (86.2 % vs. 74.2 %, P < 0.001). Using the combined technique significantly increased the SLN detection rate particularly in post-NAC compared to Tc-99m alone (93.8 % vs 85.4 %, P < 0.05) with a false negative rate of 2.1 %.

Conclusions

ICG demonstrated high sensitivity for SLN detection, comparable to Tc-99m in both upfront surgery and NAC settings. Using dual tracers also significantly improved the SLN detection rate in post-NAC setting, suggesting that ICG may serve as an effective alternative tracer for SLN mapping, regardless of NAC.

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吲哚菁绿与Tc-99m在乳腺癌前哨淋巴结活检中的比较疗效：前期手术和新辅助化疗后

本回顾性研究旨在比较吲哚菁绿（ICG）、锝-99 （Tc-99m）和联合技术（ICG + Tc-99m）在临床淋巴结阴性早期乳腺癌患者术前和术后新辅助化疗（NAC）中前哨淋巴结（SLN）检测的敏感性。方法纳入2021年12月至2024年5月期间接受乳腺手术并进行SLN活检的乳腺癌患者。在SLN活检中，ICG和Tc-99m联合使用。主要结局是比较ICG、Tc-99m和联合技术的SLN检出率（每例）和节点检出率（每个节点）。结果176例患者（术前128例，术后48例）共发现sln 326例。ICG和Tc-99m在术前（96.1%比95.3%,P = 0.65）和术后（89.6%比85.4%,P = 0.41） SLN检出率无显著差异。与Tc-99m相比，ICG组鉴定出的sln的平均数量更高(1.6±1.0比1.4±0.9,P <；0.001)。ICG的总淋巴结检出率高于Tc-99m (86.2% vs. 74.2%, P <；0.001)。与单独使用Tc-99m相比，使用联合技术显著提高了SLN的检出率，特别是在nac后（93.8% vs 85.4%）。0.05)，假阴性率为2.1%。结论在术前和NAC情况下，sicg对SLN的检测具有高灵敏度，与Tc-99m相当。使用双示踪剂也显著提高了NAC后SLN的检出率，这表明ICG可能是一种有效的SLN定位替代示踪剂，与NAC无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Journal of Surgery 医学-外科

CiteScore

3.60

自引率

31.40%

发文量

1589

审稿时长

33 days

期刊介绍： Asian Journal of Surgery, launched in 1978, is the official peer-reviewed open access journal of the Asian Surgical Association, the Taiwan Robotic Surgery Association, and the Taiwan Society of Coloproctology. The Journal is published monthly by Elsevier and is indexed in SCIE, Medline, ScienceDirect, Scopus, Embase, Current Contents, PubMed, Current Abstracts, BioEngineering Abstracts, SIIC Data Bases, CAB Abstracts, and CAB Health. ASJSUR has a growing reputation as an important medium for the dissemination of cutting-edge developments in surgery and its related disciplines in the Asia-Pacific region and beyond. Studies on state-of-the-art surgical innovations across the entire spectrum of clinical and experimental surgery are particularly welcome. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance.