7P - Comparison of the indocyanine green dye method versus the combined method of indigo carmine blue dye with indocyanine green fluorescence imaging for...

Date 08 May 2014
Event IMPAKT 2014
Session Welcome reception and Poster Walk
Topics Breast Cancer, Early Stage
Breast Cancer, Locally Advanced
Imaging, Diagnosis and Staging
Presenter Nobuyuki Takemoto
Citation Annals of Oncology (2014) 25 (suppl_1): i3-i3. 10.1093/annonc/mdu063
Authors N. Takemoto1, A. Koyanagi2, H. Yamamoto3, K. Shimura4, R. Fujii4
  • 1Breast & Endocrine Surgery, Surgical Gastroenterology, Japan Medical Alliance Higashi Saitama General Hospital, 3400153 - Saitama/JP
  • 2Research And Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de LLobregat, Barcelona/ES
  • 3Geriatric Health Service Facility (cosmos), Japan Medical Alliance Yokohama Stroke and Brain Center, YOKOHAMA/JP
  • 4Surgical Gastroenterology, Japan Medical Alliance Higashi Saitama General Hospital, Saitama/JP



Fluorescence imaging (FI) has been proposed as an alternative to both dye and gamma probe-guided methods for sentinel lymph node (SLN) biopsy. However, this procedure is complicated and requires technical skills because the shadowless surgical lights must be turned off to visualize the fluorescence through a monitor. In 2011, we introduced a novel combined method (CM) consisting of the blue dye method and FI. The identification of SLNs under direct inspection is facilitated by the addition of the blue dye, and FI assists in the pre-operative identification of lymphatic channels, the decision for incision and intra-operative detection of non-stained SLNs. We compared the SLN detection rates of CM with that of the ICG dye method (IDM) alone


A total of 106 patients with stage I or II breast cancer who underwent breast conservative therapy since June 2008 were reviewed. All cases from November 2011 were CM cases (n = 55) and those before then were IDM cases (n = 51). Details of the two methods are as follows: (1) IDM: 2 ml of ICG (10 mg) was used and the green-stained SLNs were resected via a 3–4 cm axillary incision; (2) CM: A combination of 1 ml of ICG (5 mg) and 1–3 ml of indigo carmine (4–12 mg) was used. A 2 cm incision was made near the point of disappearance of the fluorescence using Photodynamic Eye (PDE) and the blue-stained SLNs were resected.


An average of 3.02 and 1.96 SLNs were identified with IDM and CM respectively. Blue dye with ICG without the use of PDE resulted in a non-significant higher SLN detection rate than IDM (89.1% vs. 82.4%). With the use of PDE (CM), a significantly higher proportion of SLNs was detected compared to IDM (96.4% vs. 82.4%; Fisher's exact test p = 0.018). No side effects with CM were observed.


CM is a safe, efficient and cost-effective method to identify SLNs. It maintains the advantages of the dye- and gamma probe-guided methods in terms of its operability under room light conditions and smaller incision with the further benefit of avoiding radiation exposure. This method is also feasible in institutions where the use of radioisotope is limited.


All authors have declared no conflicts of interest.