Sentinel Lymph Node Identification for Breast Cancer Patients Using Fluorescence Navigation with Indocyanine Green: Early Experience at Lampang Hospital
DOI:
https://doi.org/10.64387/tjs.2026.278495Keywords:
Breast cancer, Indocyanine green, Blue dye, Sentinel lymph node biopsyAbstract
Background: Breast cancer is the most common malignancy among women. Axillary lymph node status is a key determinant of prognosis and treatment decisions. Although axillary lymph node dissection (ALND) provides accurate staging and regional control, it is associated with higher morbidity. Sentinel lymph node biopsy (SLNB) has therefore become the standard approach for axillary staging and avoiding unnecessary dissection. Indocyanine green (ICG) has recently been used as an alternative technique for sentinel lymph node localization via fluorescence imaging. This study presents a case series using ICG fluorescence navigation in breast cancer surgery.
Materials and Methods: From June 2022 to June 2024, 18 breast cancer patients underwent SLNB with ICG fluorescence navigation at Lampang Hospital. All patients had been diagnosed with breast cancer. These 18 patients included clinically node-negative cases and node-negative-to-positive patients (N1 to N0) who received neoadjuvant systemic treatment and underwent SLNB (dual mapping: standard isosulfan blue dye with ICG).
Results: Eighteen cases underwent sentinel lymph node biopsy (SLNB) using dual mapping with standard isosulfan blue dye and ICG for localization. No adverse events occurred from intraoperative use of ICG or blue dye. All lymph nodes visualized with either fluorescence or dye were excised. In total, we removed 75 lymph nodes across 18 procedures. ICG identified seventy nodes, while only 29 were detected with blue dye. On average, the ICG method detected 3.88 sentinel lymph nodes (SLNs) (range: 2-8), resulting in a detection rate of 100%. In comparison, only 1.61 SLNs (range: 0-4) were identified, with an identification rate of 88.88%.
Conclusion: Fluorescence-guided SLNB with ICG is safe and highly effective, improving detection rates compared to dye alone. This method enhances lymphatic mapping and supports surgical training for both surgeons and residents.
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