Annals of Surgical Oncology

, Volume 23, Issue 1, pp 44–50 | Cite as

Evaluation of the Clinical Utility of the ICG Fluorescence Method Compared with the Radioisotope Method for Sentinel Lymph Node Biopsy in Breast Cancer

  • Tomoharu Sugie
  • Takayuki Kinoshita
  • Norikazu Masuda
  • Terumasa Sawada
  • Akira Yamauchi
  • Katsumasa Kuroi
  • Tetsuya Taguchi
  • Hiroko Bando
  • Hiroyasu Yamashiro
  • Tecchuu Lee
  • Nobuhiko Shinkura
  • Hironori Kato
  • Takafumi Ikeda
  • Kenichi Yoshimura
  • Hanae Ueyama
  • Masakazu Toi
Breast Oncology



This study compared the clinical utility of indocyanine green (ICG) fluorescence and radioisotope (RI) for sentinel lymph node (SLN) detection in breast cancer.


Women with node-negative breast cancer underwent SLN biopsy using ICG fluorescence and RI. The primary end point was the sensitivity of ICG fluorescence compared with RI in the patients with tumor-positive SLNs. Secondary end points included detection rates for SLN, the additive effect of ICG fluorescence to RI, signature of positive SLNs according to tier, and adverse events related to ICG administration.


A total of 847 women with clinical node-negative breast cancer underwent SLN biopsy, and 821 patients were included in the per-protocol analysis. SLN mapping was performed using ICG fluorescence and RI. The overall detection of SLNs using ICG fluorescence was identical to RI (97.2 vs. 97.0 %, P = 0.88), and the combination of both methods achieved a significant improvement compared with RI alone (99.8 vs. 97.0 %, P < 0.001). The detection rate for tumor-positive SLN was 93.3 % for ICG fluorescence and 90.0 % for RI, and the sensitivity of the ICG fluorescence method was 95.7 % (95 % CI 91.3–98.3, P = 0.11). The additional use of ICG significantly improved positive SLN detection for RI (97.2 vs. 90.0 %, P < 0.001). There were no serious adverse events related to hypersensitivity to ICG.


The ICG fluorescence method may be an acceptable alternative to SLN detection using RI in breast cancer.


Sentinel Lymph Node Sentinel Lymph Node Biopsy Positive Sentinel Lymph Node Sentinel Lymph Node Detection Completion Axillary Lymph Node Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by research funding from Hamamatsu Photonics. The authors thank Akira Shimizu and Masahiro Takada for scientific advice and the staff of Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, for their valuable help.


T.S. received honoraria from Hamamatsu Photonics. The other authors declare no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Tomoharu Sugie
    • 1
  • Takayuki Kinoshita
    • 2
  • Norikazu Masuda
    • 3
  • Terumasa Sawada
    • 4
  • Akira Yamauchi
    • 5
  • Katsumasa Kuroi
    • 6
  • Tetsuya Taguchi
    • 7
  • Hiroko Bando
    • 8
  • Hiroyasu Yamashiro
    • 9
  • Tecchuu Lee
    • 10
  • Nobuhiko Shinkura
    • 11
  • Hironori Kato
    • 12
  • Takafumi Ikeda
    • 13
  • Kenichi Yoshimura
    • 14
  • Hanae Ueyama
    • 13
  • Masakazu Toi
    • 15
  1. 1.Department of SurgeryKansai Medical UniversityHirakataJapan
  2. 2.National Cancer Center HospitalTokyoJapan
  3. 3.National Hospital Organization Osaka National HospitalOsakaJapan
  4. 4.Department of Breast Surgery OncologyShowa University School of MedicineTokyoJapan
  5. 5.Tazuke-Kofukai Medical Research InstituteKitano HospitalOsakaJapan
  6. 6.Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome HospitalTokyoJapan
  7. 7.Department of Endocrine and Breast SurgeryKyoto Prefectural University of MedicineKyotoJapan
  8. 8.Department of Breast and Endocrine Surgery, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  9. 9.Tenri HospitalTenriJapan
  10. 10.Japanese Red Cross Kyoto Daiichi HospitalKyotoJapan
  11. 11.Kyoto Breast Center Sawai Memorial ClinicKyotoJapan
  12. 12.Kobe City Medical Center General HospitalKobeJapan
  13. 13.Institute for Advancement of Clinical and Translational ScienceKyoto University HospitalKyotoJapan
  14. 14.Innovative Clinical Research CenterKanazawa University HospitalKanazawaJapan
  15. 15.Department of Breast SurgeryGraduate School of Medicine, Kyoto UniversityKyotoJapan

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