Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index

Samantha Ng (Lead / Corresponding author), Vassilis Pitsinis, Emad H. Elseedawy, Douglas Brown, Alessio Vinci, Benjamin A. Jones, E. Jane Macaskill

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
43 Downloads (Pure)


Introduction: A recent meta-analysis [Lancet Oncol. 2010;11:908-909] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI).

Materials and methods: All consecutive patients undergoing sentinel lymph node biopsies (SLNBs) for early breast cancer in NHS Tayside were included in a prospective audit of surgical and pathology findings. All patients included in the study received dual injection of patent blue dye and ICG. Approval was obtained from the local Caldicott guardian for collection and use of personal data.

Results: Of 239 cases, all were female patients of mean age 62 years (range 27-93). In 4.2% (10/239) of cases, neither blue dye nor ICG was present in the axilla. Of the remaining 229 SLNB cases in this series, surgeons documented retrieval of 451 nodes, with a mean surgical nodal count per case of 1.97 (range 1-5) and pathological nodal count of 2.15 (range 0-7). Eighty three cases were performed in patients with BMI 30-39.9 and 21 cases with BMI ≥40, with nodal detection rates of 96.4% (80/83) and 95.2% (20/21), respectively, in these groups of patients. Twenty percent (48/229) of cases had nodal metastases on histopathology.

Conclusions: This is a large single-center study which demonstrates the safety and accuracy of the combined ICG and blue dye technique for SLNB in breast cancer. This is represented by nodal detection rates and node positivity rates which are comparable to previous multicenter studies of standard SLNB regardless of BMI.

Original languageEnglish
Pages (from-to)230-236
Number of pages7
JournalEuropean Surgical Research
Issue number2
Early online date21 Nov 2022
Publication statusPublished - 21 Jun 2023


  • Humans
  • Female
  • Adult
  • Middle Aged
  • Aged
  • Aged, 80 and over
  • Male
  • Sentinel Lymph Node Biopsy/methods
  • Indocyanine Green
  • Breast Neoplasms/diagnostic imaging
  • Body Mass Index
  • Coloring Agents
  • Lymphatic Metastasis
  • Radioisotopes
  • Lymph Nodes/pathology
  • Breast cancer
  • Indocyanine green
  • Body mass index
  • Sentinel lymph node biopsy

ASJC Scopus subject areas

  • Surgery


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