Does ICG have Time-Dependent Effects on the Lymphatic System in Women after Breast Cancer Surgery?

Near infrared fluorescence imaging (NIRFI) with Indocyanine Green (ICG) has been shown to detect lymph leakages and pat-terns in patients with complete axillary lymph node dissection (CALND) for breast cancer. However, ICG has also been demonstrated to have toxic effects in the ophthalmological field and limited data (in animal and human studies) suggest that it can alter functioning of the lymphatic system. The current study investigates pre-operative (Pre) and per-operative (Per) ICG administration and the volumes (V) of liquids collected in drains (Vd) and/or punctures (needle aspiration) (Vp) after breast cancer surgery. Fifty-five patients had one subcutaneous ICG injection in the ipsilateral hand either the day before (group Pre; n = 26) or the day of the surgery (group Per: n = 29). Vd, Vp and Vt (=Vd+Vp) were compared. The two groups did not differ statistically. We observed a statistical tendency (p=0.07) to find lower fluid volumes, overall (Vt) and in aspirations (Vp), when ICG was injected the day before the operation (Pre) compared with the same day (Per). When no fluorescence (no lymph leakage from the arm) was detected in the fluid collections, Vd and Vt were statisti-cally significantly lower in the pre-op group and in the whole group but not in the per-op one. Our correlation results add additional evidence to suggest that ICG may have a causative effect on the lymphatic system depending on the duration of its exposure as observed in the ophthalmological field. Although further study is needed to confirm, lymphologists, angiologists, lymphatic surgeons, vascular surgeons, and others who are using ICG for their NIRFLI evaluations should be aware of possible risks and complications associated with this procedure for use in patients with lymphedema.