Bio-Optical Devices in Indocyanine Green Fluorescence Guided Sentinel Node Biopsy for Breast Cancer

Background: The indocyanine green (ICG) fluorescence method is a newly developed technology to facilitate the sentinel node biopsy with the guidance of ICG fluorescence images. However, the surgical technique is still difficult, since the sentinel node cannot be indentified before skin incision and careful dissection of the subcutaneous lymphatic vessels is necessary. In this paper, an axillary pressing technique is introduced. Materials and methods: The subcutaneous lymphatic vessels just under the skin were easily detectable, but the detection of the sentinel nodes deep under the skin was difficult by ordinary observation of the fluorescence images. By pressing the axillary skin against the chest wall, the sentinel node is close to the skin and the fluorescence signal becomes intense enough to be detected. The skin incision was made on the pressure-induced fluorescent spot, and the sentinel node was directly approached with the guidance of fluorescence without dissecting the subcutaneous lymphatic vessels. Results: Pressure-induced fluorescence signal in the axilla was observed in all of 36 cases. Direct approach to the axillary sentinel nodes without tracing the subcutaneous lymphatic vessels was successful in 33 cases. Conclusions: The ICG fluorescence method is reliable and little training is required. The axillary pressing technique is useful to make it more popular.