Comparative efficacy of indocyanine green and Tc-99m for sentinel lymph node biopsy in breast cancer: Upfront surgery and post-neoadjuvant chemotherapy
Issued Date
2025-01-01
Resource Type
ISSN
10159584
eISSN
02193108
Scopus ID
2-s2.0-86000562547
Journal Title
Asian Journal of Surgery
Rights Holder(s)
SCOPUS
Bibliographic Citation
Asian Journal of Surgery (2025)
Suggested Citation
Tarapongpun T., Lai H.W., Liao C.Y., Lin S.L., Huang H.I., Chen S.T., Chen D.R. Comparative efficacy of indocyanine green and Tc-99m for sentinel lymph node biopsy in breast cancer: Upfront surgery and post-neoadjuvant chemotherapy. Asian Journal of Surgery (2025). doi:10.1016/j.asjsur.2025.01.045 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/106772
Title
Comparative efficacy of indocyanine green and Tc-99m for sentinel lymph node biopsy in breast cancer: Upfront surgery and post-neoadjuvant chemotherapy
Corresponding Author(s)
Other Contributor(s)
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.