The Impact of Temporal Variation in ICG Administration on Axillary Node Identification During Reverse Mapping...

Area of Science:

• Oncology
• Surgical Oncology
• Medical Imaging

Background:

• Indocyanine green (ICG) is utilized with other tracers for identifying axillary lymph nodes (LN) in breast cancer surgery.
• Accurate identification of sentinel lymph nodes (SLN) and arm lymph nodes (ARM LN) is critical for staging and treatment planning.
• The timing of ICG administration (pre-operative vs. per-operative) may influence the detection rates of these nodes.

Purpose of the Study:

• To evaluate the impact of pre-operative versus per-operative ICG injection timing on the identification of ARM LN.
• To compare the detection rates of fluorescent lymph nodes between patients receiving ICG the day before surgery and those receiving it on the day of surgery.

Main Methods:

• A study involving 109 women undergoing breast cancer surgery (lumpectomy or mastectomy) with either SLN biopsy or complete axillary node dissection (CALND).
• Participants received a subcutaneous injection of ICG in the hand's first interdigital space either the day before surgery (pre-op subgroup) or on the day of surgery (per-op subgroup).
• Fluorescent characteristics of SLN and axillary LN were analyzed and compared between the two injection timing groups.

Main Results:

• No significant differences were observed in basic patient characteristics between the pre-operative and per-operative ICG injection groups.
• The detection rates for fluorescent SLN (28%), fluorescent LN in CALND (74.5%), and the percentage of fluorescent LN in CALND (38.5%) were not significantly different between the groups.
• The timing of ICG injection did not significantly impact the identification of ARM LN or SLN.

Conclusions:

• Injecting ICG in the hand the day before or on the same day as breast cancer surgery does not significantly influence the detection of arm lymph nodes in this study.
• The timing of ICG injection is an independent variable with no discernible effect on the detection results, offering flexibility in surgical planning.
• This finding allows for either pre-operative or per-operative ICG administration, simplifying the procedure for clinicians.