Clinical application value of indocyanine green fluorescence tracing, methylene blue tracing, and their combined use in sentinel lymph node biopsy for breast cancer

doi:10.3969/j.issn.1009-976X.2024.06.004

Abstract

Abstract: Objective We aimed to assess the efficacy, safety, and practicality of indocyanine green （ICG）, methylene blue （MB）, and their combination in sentinel lymph node biopsy （SLNB）. Methods From August 2021 to August 2022, a total of 180 early-stage female breast cancer patients were enrolled and randomly assigned to three groups： the indocyanine green （ICG group, 60 cases）, the methylene blue （methylene blue group, 60 cases）, and the combination of indocyanine green and methylene blue （combination group, 60 cases） for sentinel lymph node biopsy. The primary endpoint of the study was the success rate of sentinel lymph node biopsy among the three groups. Results In the ICG group, sentinel lymph node biopsy was successful in 58 cases （success rate of 96.67%, 95% CI： 88.47-99.59）; in the methylene blue group, biopsy was successful in 56 cases （success rate of 93.33%, 95% CI： 83.80-98.15）; and in the combination group, biopsy was successful in all 60 cases （success rate of 100%, 95% CI： 94.04-100.00）. This study demonstrates that the success rates of sentinel lymph node biopsy are high in all groups-ICG, methylene blue, and combination-and there is no significant difference in success rates among the groups （P=0.168）. Conclusion The detection rate of sentinel lymph nodes （SLNs） achieved with ICG fluorescence tracing is comparable to that attained with methylene blue tracing. However, the dual-tracing technique that integrates ICG with methylene blue demonstrates an even higher detection rate. Consequently, both single ICG fluorescence tracing and the combined approach of ICG and methylene blue dual-tracing are viable options for sentinel lymph node biopsy （SLNB） in patients diagnosed with early-stage breast cancer.

Key words: indocyanine green, methylene blue, sentinel lymph node, breast cancer

摘要： 目的探讨吲哚菁绿荧光示踪法、亚甲蓝示踪法及联合示踪法在前哨淋巴结活检术中的应用价值。方法 2021年8月至2022年8月,共有180例早期女性乳腺癌患者入组,并随机分组使用吲哚菁绿（ICG组,60例）、亚甲蓝（亚甲蓝组,60例）和吲哚菁绿联合亚甲蓝（联合组,60例）进行前哨淋巴结活检术,主要研究终点是三组前哨淋巴结活检成功率。结果 ICG组前哨淋巴结活检成功58例（成功率为96.67%,95%CI：88.47-99.59）;亚甲蓝组活检成功56例（成功率为93.33%,95%CI：83.80-98.15）;联合组活检成功60例（成功率为100%,95%CI：94.04-100.00）。本研究显示,无论是ICG组、亚甲蓝组还是联合组,前哨淋巴结活检的成功率均较高,且各组间的成功率无显著差异（P=0.168）。结论 ICG荧光示踪法SLN检出率与亚甲蓝示踪相似,ICG联合亚甲蓝的双示踪方法检出率更高,ICG荧光单示踪或联合亚甲蓝双示踪可用于早期乳腺癌患者的SLNB。

关键词: 吲哚菁绿, 亚甲蓝, 前哨淋巴结, 乳腺癌

CLC Number:

R737.9

FANG Qin, CHEN Shu-ru, PENG Hong-bin, HUANG Yu-kang. Clinical application value of indocyanine green fluorescence tracing, methylene blue tracing, and their combined use in sentinel lymph node biopsy for breast cancer[J]. Lingnan Modern Clinics In Surgery, 2025, 24(06): 360-365.

方勤, 陈淑如, 彭鸿彬, 黄宇康. 吲哚菁绿荧光示踪法、亚甲蓝示踪法及二者联合应用在乳腺癌前哨淋巴结活检术中的临床应用价值[J]. 岭南现代临床外科, 2025, 24(06): 360-365.

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