A new concept for axillary treatment of primary breast cancer using indocyanine green fluorescence imaging

Sentinel lymph node (SLN) biopsy using fluorescence indocyanine green (fICG) method can visualize lymphatic vessels by real-time imaging and is technically straightforward. Identification and false-negative rates of SLN biopsy using fICG ranged from 93 to 100 % and 0 to 10 %, respectively, which were comparable to blue dye or radioisotope method. Four SLNs should be removed for the accurate staging of the axillary lymph node status. The fICG method seems to be advantageous for effective SLN dissection by the intraoperative visualization of a sentinel node bed. However, the number of SLNs removed can be adjusted by the risk of lymph node metastasis. SLN biopsy after preoperative systemic therapy (PST) in patients with clinical node positive is still challenging. There may be some advantage in fICG method for SLN detection after PST because the fICG method can identify an average of three SLNs. A prospective study to evaluate the accuracy of SLN identification using fICG after PST in node-positive patients is now warranted.