Outpatient revisits associated with three sentinel lymph node detection techniques for breast cancer: A propensity score weighted analysis

Introduction

This study evaluates whether near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is associated with a lower outpatient (OP) revisit rate compared to isosulfan blue (IB) or methylene blue (MB) when combined with technetium-99m (Tc99m) for sentinel lymph node (SLN) mapping of breast cancer.

Materials and methods

This retrospective observational study included adult female patients with a breast cancer diagnosis who underwent SLN mapping and had an index OP discharge between July 1, 2017 and August 31, 2022 ​at a U.S. hospital contributing to the Premier Healthcare Database. Patients were grouped by SLN mapping method: IB ​+ ​Tc99m, MB ​+ ​Tc99m, and ICG ​+ ​Tc99m. The primary outcome was OP revisit rates at 30, 60, and 90 days post-discharge. Propensity score weighting adjusted for differences in baseline characteristics.

Results

5.6 ​% (n ​= ​60,068) of the 1,067,677 adult female patients with a breast cancer diagnosis underwent SLN mapping, and 54.9 ​% (n ​= ​32,970) met the inclusion criteria. In the propensity-weighted sample (n ​= ​2002), the ICG ​+ ​Tc99m cohort had the lowest OP revisit rates at all time points compared to IB ​+ ​Tc99m and MB ​+ ​Tc99m: at 30 days, 36.4 ​% vs. 43.1 ​% vs. 43.2 ​%; at 60 days, 50.9 ​% vs. 55.8 ​% vs. 56.2 ​%; and at 90 days, 55.9 ​% vs. 59.7 ​% vs. 60.0 ​% (all p ​< ​.05). Adjusted odds ratios (aORs) confirmed the ICG ​+ ​Tc99m cohort's reduced OP revisits: 30-day aOR, 0.74 (0.63–0.88); 60-day aOR, 0.80 (0.68–0.94); and 90-day aOR, 0.84 (0.71–0.99) (all p ​< ​.05).

Conclusion

NIRF with ICG ​+ ​Tc99m was associated with significantly fewer OP revisits, suggesting that this method may improve patient outcomes and the continuum of care for breast cancer patients.