Sentinel Lymph Node Mapping (SLNM) in breast tissue using ICG

This video shows the application of the Quest Spectrum Platform for the detection of the SLN.

In this procedure a sentinel lymph node (SLN) is detected in an open surgery using ICG as a fluorescent marker. ICG accumulates in the SLN and assists in the detection and excision of the lymph node in breast tissue.

To determine the staging in breast cancer, assessment of metastasis of the first tumor draining lymph, the sentinel lymph node (SLN), is vital.

The  gold standard for the detection of the SLN involves the application of Technetium, a radioisotope with a high SLN detection rate. Unfortunately Technetium does not allow intraoperative visualization. It is therefore combined with Patent Blue, a staining agent with a low detection rate and known to color the breast blue for a considerable time (tattooing).

To overcome the limitations of this exhaustive procedure a growing number of hospitals is performing SLNM in breast tissue using indocyanine green (ICG).

Links to supporting literature:

The use of indocyanine green to detect sentinel nodes in breast cancer: A prospective study
Samorani et al.,
European Journal of Surgical Oncology (EJSO) 2015 vol: 41 (1) pp: 64-70

Icg Versus 99tc in Breast Surgery-How to Match Quality Health Care and Costs Reduction: A Cost Effectiveness Study
Cattin et al.
Journal of Cancer Science & Therapy 2017 vol: 09 (02)

Near-infrared fluorescence sentinel lymph node mapping in breast cancer: a multicenter experience
Verbeek et al.
Breast Cancer Research and Treatment 2014 vol: 143 (2) pp: 333-342

Randomized comparison of near-infrared fluorescence imaging using indocyanine green and 99(m) technetium with or without patent blue for the sentinel lymph node procedure in breast cancer patients
van der Vorst et al.
Annals of surgical oncology 2012 vol: 19 (13) pp: 4104-11

Motivations to choose ICG in case of SLNM:

  • SLN detection rate similar to Technetium and higher than Patent Blue
  • Good intraoperative visualization
  • No use of radiation
  • No tattooing
  • Saving the cost of applying Technetium (± €1350 per case)
  • Patient hospitalization is a day shorter
  • Less logistics trouble when Technetium has to be obtained from another hospital

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