Evaluation of preoperative lymphatic drainage imaging using indocyanine green for precise sentinel lymph node biopsy in breast cancer patients

BACKGROUND: Sentinel lymph node (SLN) biopsy (SLNB) is the preferred surgical treatment for patients with clinically diagnosed node-negative breast cancer. However, failure to detect SLN(s) and postoperative adverse reactions have led to continuous refinement regarding this procedure. As such, the present study explored the application of preoperative lymphatic drainage imaging using indocyanine green (ICG) for more precise SLNB. METHODS: A total of 144 patients with breast cancer were divided into two groups, intraoperative localization (IOL) and preoperative localization (POL) groups, and the chi-squared test was used to compared SLN detection rates. ICG concentration and injection time were evaluated to determine the appropriate preoperative localization procedure. The application of preoperative lymphatic drainage imaging in breast-conserving surgery was further assessed in another 7 patients. RESULTS: SLNs were successfully detected in 134 of 144 patients with breast cancer; more specifically, SLN detection rates in the IOL and POL groups were 88.10% and 100%, respectively (P=0.015). Injection of ICG solution diluted 1:100 three days before surgery clearly developed a lymphatic drainage pathway without residual fluorescence affecting intraoperative SLN detection. Moreover, the application of preoperative lymphatic drainage imaging facilitated the identification of SLNs in all seven patients with breast cancer who underwent breast-conserving surgery through a single-point injection of tracers. CONCLUSIONS: This study describes a reliable means of achieving preoperative localization of the lymphatic drainage pathways, which can not only avoid SLN detection failure due to intraoperative biopsy-caused lymphatic injury, but also help to actualise single-point injection to improve the postoperative aesthetics of the breast.