Indocyanine green with methylene blue dye as an alternative to standard dual dye technique for sentinel lymph node biopsy in node-negative early breast cancer: Experience from a tertiary cancer institute

ABSTRACT Background: Sentinel lymph node (SLN) biopsy by a dual technique using technetium and methylene blue (MB) is a standard method of assessing the axilla in node-negative breast cancer. However, technetium has few drawbacks and not easily available, especially during the situation like COVID-19 pandemic. This warrants for the development of alternate techniques of SLN biopsy replacing the technetium. Methods: A retrospective study of prospectively entered data was collected from 1 st of January to 31 st of December 2020 in a tertiary cancer center in India. A total of 86 node-negative breast cancer patients, who underwent SLN biopsy using dual technique either by technetium and MB or indocyanine green (ICG) and MB were studied. There were 52 patients in technetium and MB group and 34 patients in the indocyanine green and MB group. Results: There was no statistically significant difference in age, quadrant of a tumor, type of surgery, histopathology, grade, size of tumor, and hormone receptor status between the groups. Both techniques had similar identification rates, mean sentinel nodes removed, and SLN positivity rate. Conclusion: In circumstances where technetium is not available, ICG with MB can be considered as a safe alternative technique for SLN biopsy.