In groundbreaking research that promises to refine the approach to breast cancer surgeries, clinicians from the University Hospital in Saint-Etienne, France, add crucial evidence favoring a combined method for sentinel lymph node (SLN) detection. The findings, recently published in Scientific Reports, advocate the use of indocyanine green fluorescence alongside the conventional radioactive tracer, potentially moving away from the traditional use of patent blue dye—a shift that can minimize risks and improve detection accuracy.

Introduction to Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy (SLNB) has become a pivotal procedure in the management of breast cancer, allowing surgeons to determine the extent of cancer spread. The sentinel lymph nodes are the primary nodes that drain lymph from the cancer site and thus the first nodes that cancer cells are likely to spread to. Identifying and analyzing these nodes for cancer cells helps determine the need for more extensive lymph node removal and guides the postoperative treatment strategy.

To date, the combination of a blue dye and a radioactive substance has been the standard approach to locate the sentinel nodes during surgery. However, issues such as allergic reactions to the blue dye and logistical challenges in the use of radioisotopes have led to the search for alternative methods.

The Study and Its Impact

Led by Dr. Céline Chauleur and her team, including Charlotte Vermersch, Tiphaine Raia-Barjat, Céline Chapelle, and Suzanne Lima from the INSERM U1059 and University of Lyon, this study is a randomized controlled trial involving 99 patients with breast cancer undergoing SLNB. Published with a DOI: 10.1038/s41598-019-43473-3, the article explores the effectiveness of a technique combining indocyanine green (ICG) fluorescence with the standard radioactive tracer, technetium-99m (99mTc), in the detection of sentinel lymph nodes.

Key highlights of the study reveal that the use of ICG fluorescence significantly enhances the SLN detection rate when used in conjunction with the standard radioisotope method. This research not only establishes the safety and efficacy of this combined technique but also sets the stage for an improved standard of care in breast cancer surgeries, given that the ICG method is both less invasive and free of the severe allergic reactions associated with patent blue dye.

Moreover, the research aligns with previous studies cited within its references, which have demonstrated the potential of fluorescence imaging in SLNB. Such innovations represent significant advances in surgical oncology, holding the promise of reduced complications, improved patient experience, and better clinical outcomes.

The Science Behind Indocyanine Green Fluorescence

ICG is a water-soluble fluorophore that emits near-infrared light when excited by a specific wavelength. It binds rapidly to plasma proteins and can be visualized with near-infrared imaging systems. When injected near the tumor, ICG travels through the lymphatic vessels to the sentinel lymph nodes, which can then be visualized in real-time, providing the surgeon with immediate visual feedback.

The study’s success in SLN detection using this technique underlines the specificity and utility of ICG and may influence a departure from the dual use of blue dye, thus mitigating the overall patient risk during surgical procedures.

Implications for Future Breast Cancer Surgeries

The results from the Saint-Etienne University Hospital could have far-reaching effects on how sentinel lymph node biopsies are performed worldwide. With patient safety at the forefront, practices focusing on the application of ICG fluorescence are poised to rapidly gain acceptance.

Additionally, this method could revamp the workflow within surgical suites, alleviating the need for blue dye and its associated preparations. The use of ICG may streamline the process, enable faster operative times, and ensure that cancer care stays attuned to technological advances and patient-centered approaches.

The Global Reception and Next Steps

This breakthrough has captured the attention of oncological surgeons and cancer care providers globally. Driven by evidence-based medicine, healthcare practitioners are constantly seeking improvement in surgical precision and outcome for their patients. With additional studies reinforcing the benefits of combined ICG fluorescence and radioisotope methods for SLNB, a significant shift towards the adoption of this technique can be anticipated.

For patients, the potential roll-out of this method means less risk of allergic reaction, potentially fewer side effects, and more efficient surgeries—factors that contribute significantly to the overall success and recovery from breast cancer operations.

Keywords

1. Sentinel lymph node biopsy
2. Breast cancer surgery
3. Indocyanine green fluorescence
4. SLNB detection methods
5. Surgical oncology advancements

References

1. Vermersch, C., Raia Barjat, T., Perrot, M., Lima, S., & Chauleur, C. (2016). Place of indocyanine green coupled with fluorescence imaging in research of breast cancer sentinel node. Bulletin du Cancer, 103(4), 381-388. doi: 10.1016/j.bulcan.2016.01.015
2. Van der Vorst, J. R., Schaafsma, B. E., Verbeek, F. P. R., Keereweer, S., Jansen, J. C., van der Velden, L. A., … & Lowik, C. W. G. M. (2012). Randomized Comparison of Near-Infrared Fluorescence Imaging Using Indocyanine Green and 99(m) Technetium with or without Patent Blue for the Sentinel Lymph Node Procedure in Breast Cancer Patients. Annals of Surgical Oncology, 19(13), 4104-4111. doi: 10.1245/s10434-012-2466-4
3. Jung, S. Y., Kim, S. K., Kim, S. W., Kwon, Y., Lee, E. S., Kang, H. S., … & Nam, S. J. (2014). Comparison of sentinel lymph node biopsy guided by the multimodal method of indocyanine green fluorescence, radioisotope, and blue dye versus the radioisotope method in breast cancer: A randomized controlled trial. Annals of Surgical Oncology, 21(4), 1254-1259. doi: 10.1245/s10434-013-3437-0
4. Lyman, G. H., Somerfield, M. R., Bosserman, L. D., Perkins, C. L., Weaver, D. L., & Giuliano, A. E. (2005). American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer. Journal of Clinical Oncology, 23(30), 7703-7720. doi: 10.1200/JCO.2005.08.001
5. Scientific Reports. (2019). Randomized comparison between indocyanine green fluorescence plus 99mTc for the sentinel lymph node procedure in breast cancer. Sci Rep, 9(1), 6943. doi: 10.1038/s41598-019-43473-3