Patient and tumor characteristics in breast cancer undergoing indocyanine green-guided sentinel lymph node biopsy

Abstract

Background: Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in early-stage breast cancer. Conventional methods rely on radioisotopes and blue dye, which pose limitations including radiation exposure, allergic reactions, and the need for specialized nuclear medicine infrastructure. Indocyanine green (ICG) fluorescence-guided SLNB has emerged as a safe, non-radioactive alternative. This study assesses the feasibility, sentinel node yield, and tumor characteristics in patients undergoing ICG-guided SLNB at a tertiary care center in Southern India.

Methods: A retrospective review was conducted of 60 female patients with early-stage, clinically node-negative breast cancer treated between June 2024 and December 2025. All patients underwent ICG-guided SLNB using a near-infrared fluorescence camera without the addition of blue dye or radiotracer. Data collected included patient demographics, tumor location, histological subtype, receptor status (ER, HER2), and the number of sentinel lymph nodes retrieved.

Results: The mean patient age was 53±9.1 years, and 63.3% had a BMI ≥25 kg/m². Tumors were most frequently located in the upper outer quadrant (51.7%), and invasive ductal carcinoma was the predominant histology (90%). Estrogen receptor positivity was observed in 85% of cases, and 30% were HER2-positive. A mean of 2.5±1.2 sentinel lymph nodes (range 1-6) were successfully harvested using ICG alone. No adverse events related to the technique were noted.

Conclusions: ICG-guided SLNB is a feasible, safe, and resource-efficient surgical technique, particularly valuable in low-resource settings where access to nuclear medicine is limited.