Use of indocyanine green for detecting the sentinel lymph node in breast cancer patients: from preclinical evaluation to clinical validation

PLoS One. 2013 Dec 16;8(12):e83927. doi: 10.1371/journal.pone.0083927. eCollection 2013.

Abstract

Assessment of the sentinel lymph node (SLN) in patients with early stage breast cancer is vital in selecting the appropriate surgical approach. However, the existing methods, including methylene blue and nuclides, possess low efficiency and effectiveness in mapping SLNs, and to a certain extent exert side effects during application. Indocyanine green (ICG), as a fluorescent dye, has been proved reliable usage in SLN detection by several other groups. In this paper, we introduce a novel surgical navigation system to detect SLN with ICG. This system contains two charge-coupled devices (CCD) to simultaneously capture real-time color and fluorescent video images through two different bands. During surgery, surgeons only need to follow the fluorescence display. In addition, the system saves data automatically during surgery enabling surgeons to find the registration point easily according to image recognition algorithms. To test our system, 5 mice and 10 rabbits were used for the preclinical setting and 22 breast cancer patients were utilized for the clinical evaluation in our experiments. The detection rate was 100% and an average of 2.7 SLNs was found in 22 patients. Our results show that the usage of our surgical navigation system with ICG to detect SLNs in breast cancer patients is technically feasible.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Animals
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / pathology
  • Disease Models, Animal
  • Female
  • Fluorescent Dyes* / administration & dosage
  • Fluorescent Dyes* / pharmacokinetics
  • Humans
  • Indocyanine Green* / administration & dosage
  • Indocyanine Green* / pharmacokinetics
  • Lymph Nodes / pathology*
  • Lymph Nodes / surgery
  • Lymphatic Metastasis
  • Mice
  • Middle Aged
  • Neoplasm Staging
  • Rabbits
  • Sentinel Lymph Node Biopsy

Substances

  • Fluorescent Dyes
  • Indocyanine Green

Grants and funding

This paper is supported by the National Basic Research Program of China (973 Program) under Grant No. 2011CB707700, the National Natural Science Foundation of China under Grant No. 81027002, and the Chinese Academy of Sciences Visiting Professorship for Senior International Scientists under Grant No. 2012T1G0036. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.