Sentinel Lymph Node Biopsy (SLNB) is a crucial diagnostic procedure that helps physicians identify and evaluate the first lymph node(s) affected by cancer, known as the sentinel lymph node(s). This assessment is crucial in determining whether cancer has spread beyond its primary site. One of the most recent advances in SLNB is the use of Indocyanine Green (ICG) dye, which has shown promising results in terms of accuracy and ease of use. In this article, doctors will discuss the SLNB procedure, the benefits of using ICG dye, and the potential implications for cancer staging and treatment.
The sentinel lymph node is the first lymph node that cancer cells are likely to reach if they spread from the primary tumor site. By removing and examining this node, doctors can determine if cancer has metastasized and make informed decisions about the appropriate course of treatment. The SLNB procedure typically involves the injection of a tracer, such as a radioactive (radiocolloid) substance or a dye, to help identify the sentinel lymph node(s). The tracer then travels to the sentinel node(s), allowing the surgeon to locate and remove it for further analysis.
ICG Dye: A Novel Tracer for SLNB instead of a radiocolloid
Indocyanine Green (ICG) dye is a fluorescent dye that has been increasingly adopted as a tracer in SLNB. When illuminated with near-infrared light, ICG emits a fluorescent signal that can be easily visualized using specialized imaging devices. This enables the surgeon to precisely locate the sentinel lymph node(s) and minimize the removal of non-sentinel nodes, thus reducing the risk of complications and improving the overall accuracy of the procedure.
The traditional and standard procedure for SLNB is by using radiocolloid dye and in some centres, the radiocolloid dye is coupled with isosulphan blue dye. The issue with the radiocolloid is that it requires the Department of Nuclear Medicine where the dye is brought/prepared and injected, also SPECT (Single-photon emission computed tomography) to confirm its drainage to the Lymph Nodes. Intraoperatively a special camera known as Gamma Camera (GC) is required to locate the draining lymph nodes. The ICG technique does not require association with other departments, it is usually done in the Operation room a few minutes before surgery. The localization is done by an infrared camera rather than a gamma camera. The ICG technique removes dependence on other departments and also the cost of t dye and infrastructure required is substantially less as compared to the radiocolloid method.
Another area, where ICG scores over radiocolloids is during surgery of non-palpable lesions in the breast. The radiocolloid dyes of different densities have to be used, one which remains in the lesion for GC to identify the primary lesion and the other drains to the lymph nodes for them to be located in the procedure of SLNB by GC. The ICG dye remains in the primary lesion as well as part of it drains to the lymph nodes also, no different versions of ICG dye are required making the procedure much simpler.
The ICG technique does not involve any radiation exposure as it is based on the Infra-Red principle. It also gives insights into the perfusion of tissues especially if oncoplastic breast reconstruction or re-alignment is being done.
Advantages of Using ICG Dye in SLNB
Improved accuracy: The use of ICG dye has been shown to increase or be at par in terms of the accuracy of sentinel lymph node identification in comparison to traditional techniques, such as blue dye or radiocolloid tracers. This higher accuracy can lead to more accurate staging of cancer and better-informed treatment decisions.
Real-time visualization: The fluorescence emitted by ICG dye allows for real-time visualization of the sentinel lymph node(s) during surgery. This can help surgeons make more precise incisions and minimize the risk of damage to surrounding healthy tissue.
Minimally invasive: ICG dye is well-tolerated by the body and is associated with fewer side effects compared to radioactive tracers. Moreover, the use of near-infrared light for imaging does not expose the patient or medical staff to ionizing radiation.
Cost-effective: ICG dye is relatively inexpensive compared to other tracers, making it a cost-effective option for healthcare providers.
Dr. Mandeep Singh, Chief Mentor, Art of Healing Cancer, shares "We have one of the largest experiences using ICG dye for SLNB in this part of the world. The use of ICG dye in sentinel lymph node biopsy has the potential to revolutionize the diagnosis and treatment of various cancers. It is a good choice for clinicians who want to improve patient outcomes because it is accurate, can be seen in real-time, has fewer complications, and is cost-effective. As more research is conducted, we can expect to see ICG dye become a standard tracer in SLNB, paving the way for more precise cancer staging and personalized treatment plans."
The sentinel lymph node is the first lymph node that cancer cells are likely to reach if they spread from the primary tumor site. By removing and examining this node, doctors can determine if cancer has metastasized and make informed decisions about the appropriate course of treatment. The SLNB procedure typically involves the injection of a tracer, such as a radioactive (radiocolloid) substance or a dye, to help identify the sentinel lymph node(s). The tracer then travels to the sentinel node(s), allowing the surgeon to locate and remove it for further analysis.
ICG Dye: A Novel Tracer for SLNB instead of a radiocolloid
Indocyanine Green (ICG) dye is a fluorescent dye that has been increasingly adopted as a tracer in SLNB. When illuminated with near-infrared light, ICG emits a fluorescent signal that can be easily visualized using specialized imaging devices. This enables the surgeon to precisely locate the sentinel lymph node(s) and minimize the removal of non-sentinel nodes, thus reducing the risk of complications and improving the overall accuracy of the procedure.
The traditional and standard procedure for SLNB is by using radiocolloid dye and in some centres, the radiocolloid dye is coupled with isosulphan blue dye. The issue with the radiocolloid is that it requires the Department of Nuclear Medicine where the dye is brought/prepared and injected, also SPECT (Single-photon emission computed tomography) to confirm its drainage to the Lymph Nodes. Intraoperatively a special camera known as Gamma Camera (GC) is required to locate the draining lymph nodes. The ICG technique does not require association with other departments, it is usually done in the Operation room a few minutes before surgery. The localization is done by an infrared camera rather than a gamma camera. The ICG technique removes dependence on other departments and also the cost of t dye and infrastructure required is substantially less as compared to the radiocolloid method.
Another area, where ICG scores over radiocolloids is during surgery of non-palpable lesions in the breast. The radiocolloid dyes of different densities have to be used, one which remains in the lesion for GC to identify the primary lesion and the other drains to the lymph nodes for them to be located in the procedure of SLNB by GC. The ICG dye remains in the primary lesion as well as part of it drains to the lymph nodes also, no different versions of ICG dye are required making the procedure much simpler.
The ICG technique does not involve any radiation exposure as it is based on the Infra-Red principle. It also gives insights into the perfusion of tissues especially if oncoplastic breast reconstruction or re-alignment is being done.
Advantages of Using ICG Dye in SLNB
Improved accuracy: The use of ICG dye has been shown to increase or be at par in terms of the accuracy of sentinel lymph node identification in comparison to traditional techniques, such as blue dye or radiocolloid tracers. This higher accuracy can lead to more accurate staging of cancer and better-informed treatment decisions.
Real-time visualization: The fluorescence emitted by ICG dye allows for real-time visualization of the sentinel lymph node(s) during surgery. This can help surgeons make more precise incisions and minimize the risk of damage to surrounding healthy tissue.
Minimally invasive: ICG dye is well-tolerated by the body and is associated with fewer side effects compared to radioactive tracers. Moreover, the use of near-infrared light for imaging does not expose the patient or medical staff to ionizing radiation.
Cost-effective: ICG dye is relatively inexpensive compared to other tracers, making it a cost-effective option for healthcare providers.
Dr. Mandeep Singh, Chief Mentor, Art of Healing Cancer, shares "We have one of the largest experiences using ICG dye for SLNB in this part of the world. The use of ICG dye in sentinel lymph node biopsy has the potential to revolutionize the diagnosis and treatment of various cancers. It is a good choice for clinicians who want to improve patient outcomes because it is accurate, can be seen in real-time, has fewer complications, and is cost-effective. As more research is conducted, we can expect to see ICG dye become a standard tracer in SLNB, paving the way for more precise cancer staging and personalized treatment plans."
