ArticleFrontiers in oncology2026
Comparative analysis of indocyanine green and technetium-99m for sentinel lymph node localization in breast cancer - institutional experience.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sentinel lymph node biopsy is the gold standard for axillary staging in early breast cancer. The conventional dual-tracer technique using technetium-99m (Tc-99m) and blue dye is highly effective but limited by radiation exposure and logistical complexity. Indocyanine green (ICG) fluorescence imaging offers a radiation-free, real-time alternative. This study aimed to assess the diagnostic performance and clinical feasibility of ICG-guided SLNB compared with the standard Tc-99m-nanocolloid method. Methods: This prospective, open label, single center paired diagnostic comparison trial was conducted at the Department of Surgery, University of Debrecen Clinical Centre, Hungary. Eligible patients had biopsy-confirmed ductal carcinoma Results: A total of 106 patients were included. ICG fluorescence achieved a sentinel node detection rate of 90,6%, compared with 97,1% for Tc-99m. A median of 2,1 lymph nodes were excised per patient. 21.7% received neoadjuvant systemic therapy and 63.2% had breast conserving surgery. The overall per-patient sentinel lymph node (SLN) detection rate was 90.6% with indocyanine green (ICG), 97.1% with technetium-99m (Tc-99m), and 98.1% with the combined technique. On a per-node basis (n = 221), detection rates were 88.2%, 83.7%, and 100%, respectively. Among patients with positive SLNs (n = 34), metastatic node detection was 94.1% using ICG, 79.4% with Tc-99m, and 100% with the combined approach. In both upfront surgery and neoadjuvant subgroups, no statistically significant differences were observed between detection methods (p > 0.05); however, interpretation of neoadjuvant results was limited by the small sample size. No ICG-related complications or adverse events were reported. Conclusions: ICG fluorescence-guided SLNB alone is a safe, effective, and radiation-free alternative to conventional radioisotope mapping. Its high detection accuracy, simplicity, and real-time visualization support its integration into standard breast cancer surgery protocols. Further multicenter studies are warranted to validate long-term oncological outcomes.
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