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Triple-Tracer Sentinel Node Mapping: Maximizing Detection, Minimizing Dissection.

Daniel Alin Cristian1,2, Bogdan Popescu1,3, Cristian Valentin Toma1,4

  • 1Faculty of General Medicine, Carol Davila University, 050474 Bucharest, Romania.

Life (Basel, Switzerland)
|December 30, 2025
PubMed
Summary
This summary is machine-generated.

Technetium-99m and indocyanine green are effective tracers for sentinel lymph node biopsy in breast cancer, outperforming methylene blue. A triple-tracer approach enhances detection and can reduce the number of nodes removed.

Keywords:
breast cancerindocyanine greenlymphatic mappingsentinel lymph node biopsytriple-tracer technique

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Nuclear Medicine

Background:

  • Sentinel lymph node (SLN) biopsy is crucial for breast cancer staging.
  • Commonly used tracers include technetium-99m (99mTc), indocyanine green (ICG), and methylene blue (MB).
  • Limited data exist on the comparative performance of these tracers in routine clinical practice.

Purpose of the Study:

  • To audit the performance of 99mTc, ICG, and MB in a triple-tracer approach for SLN biopsy in breast cancer.
  • To evaluate sentinel lymph node detection rates, number of nodes retrieved, and tracer concordance.
  • To assess subgroup performance, including patients undergoing mastectomy or post-neoadjuvant therapy.

Main Methods:

  • A single-center retrospective audit of 111 consecutive SLN procedures.
  • Utilized a triple-tracer method combining 99mTc, ICG, and MB.
  • Evaluated detection rates, node yield, tracer concordance, and specific patient subgroups.

Main Results:

  • Detection rates were 96.4% for 99mTc, 93.7% for ICG, and 78.4% for MB.
  • 99mTc and ICG significantly outperformed MB (p < 0.001).
  • Triple-tracer workflows improved detection odds (AUCs 0.98 for 99mTc, 0.82 for ICG).

Conclusions:

  • Technetium remains a primary tracer for SLN biopsy.
  • ICG is a valuable adjunct, enhancing visualization and detection efficacy.
  • MB provides redundancy; triple-tracer mapping offers optimal nodal identification and potentially fewer excisions with complete concordance.