Cost Analysis of Technetium-99m versus Indocyanine Green for Sentinel Lymph Node Biopsy in Breast Cancer

Sentinel lymph node biopsy (SLNB) using Technetium-99 (Tc-99) is the standard technique for axillary staging in breast cancer. However, it has logistic issues, especially in hospitals without a nuclear medicine department (NMD). As the sensitivity and specificity of indocyanine green (ICG) are comparable to those of Tc-99, the aim of this study was to perform a cost-benefit analysis of the 2 methods.

A prospective observational cohort of patients undergoing breast cancer surgery was included. Tc-99 and ICG were administered during the same procedure for SLNB. Three clinical pathways were constructed: Tc-99 administration at hospitals without NMD (first clinical pathway), Tc-99 administration at hospitals with NMD (second), and the ICG method (third). A cost comparison between the pathways was performed using the monetary unit of Euros (€).

Between April 2021 and April 2024, 112 patients with breast cancer underwent SLNB using Tc-99 and ICG detection. The total cost per patient for the first clinical pathway was €322.29, for the second, €308.29 and for the third, €61.35 per patient. The cumulative cost for 112 patients in the first and second clinical pathways (€37,216.48 and €34,528.48, respectively) resulted to be 5.2 times the cost of the ICG pathway (€6871.2). The use of ICG results in an average saving of approximately 80% of the Tc-99 expenses.

ICG is a cost-effective option as a tracer for sentinel lymph node biopsy in breast cancer. ICG also offers logistic advantages and it should be considered in clinical practice and protocols.