Abstract P3-01-15: Sentinel lymph node biopsy by indocyanine green fluorescence detection in breast cancer cT1-4N0M0 patients. Frequency of false-negative results is low
Authors: Portnoy SM , Kuznetsov AV , Shakirova NM , Kozlov NA , Maslyaev AV , Karpov AV , Kampova-Polevaya EB , Mistakopulo MG , Egorov YS , Anurova OA , Shendrikova TA , Gornostaeva AS 
Published: February 2018

Breast cancer cT1-4N0M0 patients are usually need in a sentinel lymph node biopsy (SLNB). SLNB by indocyanine green (ICG) fluorescence detection is a modern technique possessing high level of lymph node detection rate, but frequency of false-negative results was not evaluated adequately.

Objective was to determine main diagnostic characteristics of the ICG fluorescence-guided SLNB in BC cT1-4N0M0 patients: node detection rate and frequency of false-negative results.

Methods: 99 patients with 100 cases of breast cancer cT1-4N0M0 (T1 – 43, T2 – 55, T3 – 1, T4 – 1) were operated, axillary part of operation consisted from the ICG fluorescence-guided SLNB and axillary lymphadenectomy of levels I–II or I–II–III. 12 patients had neoadjuvant chemotherapy and 8 – neoadjuvant hormonotherapy. Photodynamic Eye C9830 (Hamamatsu Photonics K.K) was using for emit near infrared radiation and fluorescent image registration. 2 ml 0.25% solution of ICG were injected inra- and sub- cutaneous periareolary or in a tumor projection, 2-5 minutes later it can be see fluorescent way to axillary. The procedure starting from injection of the ICG to the identification of a signal lymph node takes 15–30 minutes.

Results. Transcutaneous fluorescent lymphatic duct was visible in all 100 procedures, but not lymphatic node. Last can be found usually in a wound after Fascia superficialis and Fascia axillaris dissection. A signal lymph node was detected in 98 cases (98 %). Mean amount of sentinel lymphatic nodes = 1.9±0.1 (1-7 nodes). Mean amount of lymphatic nodes took with axillary dissection = 10.5±0.5 (5-26 nodes). In 28 (28.6%) cases of 98 were found to have metastases in signal lymph nodes. Other than signal lymph nodes had metastatic lesion only in 35.7% in signal lymph nodes N+ cases. False negative result occurred in 3 (3.1%) cases of 98, including 2 with metastases in signal lymph node finding by plan histological investigation, but not at froze section. No cases of allergic reactions or other adverse effects were diagnosed with standard subcutaneous use of indocyanine.

Conclusion. Fluorescence technique of the detection of signal lymph nodes has its own methodological issues: in most cases a signal lymph node is not visualized through the skin, it should be visualized in surgical wound using the course of lymphatic duct as guidance. Application of ICG fluorescence-guided SLNB in cN0 breast cancer patients allows high signal lymph node detection rate and low false negative rate, - 3%.

Acknowledgments. The authors thank Professor Gordon C. Wishart for the Sentinel Lymph Node Detection by ICG Fluorescence Technique teaching.

Citation Format: Portnoy SM, Kuznetsov AV, Shakirova NM, Kozlov NA, Maslyaev AV, Karpov AV, Kampova-Polevaya EB, Mistakopulo MG, Egorov YS, Anurova OA, Shendrikova TA, Gornostaeva AS. Sentinel lymph node biopsy by indocyanine green fluorescence detection in breast cancer cT1-4N0M0 patients. Frequency of false-negative results is low [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-15.