Indocyanine Green Enhancement for Targeted Lymph Node Dissection in Axillary Staging

Background: Axillary lymph node dissection (ALND) has been the standard of care for node-positive breast cancer. However, recent advances have shown targeted axillary lymph node dissection (TALND) to be an oncologically safe and effective alternative in patients with adequate response to neoadjuvant therapy (NAT). The conventional dual-mapping technique employs a combination of a radioactive tracer and blue dye. Our study aimed to evaluate indocyanine green (ICG) as an adjunct to increase node detection in TALND. Methods: A descriptive cross-sectional study of 21 patients with biopsy-confirmed axillary lymph node metastases who underwent TALND was conducted. Prior to NAT, metastatic nodes were marked; preoperatively, localization was achieved via radiologic guidewire placement. During surgery, the marked node was excised, and sentinel node mapping was performed using a combination of ICG fluorescence, technetium-99 radiotracer, and palpation. The number and method of node detection were analyzed. Results: A total of 70 sentinel lymph nodes were identified across 21 patients, with a median of 3 nodes per patient (range, 1–7). Of these, 28 nodes (40.0%) were detected exclusively with ICG, 31 (44.3%) with both ICG and radiotracer, 4 (5.7%) solely with radiotracer, and 7 (10.0%) with palpation. Metastatic involvement was present in 7 of 21 patients (33.3%), including 2 cases in which metastatic nodes were detected only by ICG. Conclusion: ICG is a valuable adjunct for sentinel lymph node detection during TALND. Combined use of ICG and radiotracer enhances nodal identification and may reduce the need for extensive ALND in patients with clinically node-positive breast cancer.