Evaluation of the benefit of using blue dye in addition to indocyanine green fluorescence for sentinel lymph node biopsy in patients with breast cancer

BACKGROUND Near infrared-guided indocyanine green (ICG) fluorescence has vast potential for guiding sentinel lymph node biopsy (SLNB) in patients with breast cancer. The purpose of this study was to evaluate any additional clinical benefit for SLNB when blue dye is used in combination with ICG. METHODS Between November of 2009 and September of 2013, 86 patients diagnosed with breast cancer were investigated by SLNB using a combination of patent blue and ICG. A lymph node was considered as the sentinel lymph node (SLN) when it was stained with blue dye and/or fluorescence. A levelIandIIaxillary dissection was performed for verification of axillary node status after the SLNB. RESULTS The SLN identification rate of SLN for ICG-patent blue combination was comparable to that for ICG alone (98.8% versus 93%; P = 0.054), but the false-negative rate was reduced from 12% (3/25) to 4% (1/25). Twenty-four patients had positive SLNs. In two of those patients, although there were SLNs identified by both tracers, the positive SLNs were identified by blue dye only. CONCLUSION Although blue dye did not improve the identification rate significantly, there was a definite benefit in improving the false-negative rate. The use of a fluorescence method together with blue dye is an ideal method for hospitals that do not have access to conventional radiation-based detection methods.