Indocyanine Green Fluorescence-Guided Sentinel Lymph Node Biopsy in Breast Cancer Using the MARS Near-Infrared Imaging System: A Prospective Single-Center Feasibility Study
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Background
Sentinel lymph node biopsy (SLNB) is an essential component of axillary staging in breast cancer. Fluorescence-guided mapping with indocyanine green (ICG) enables real-time visualization of lymphatic drainage; however, the parameters of fluorescence-signal recording require standardization.
Objective
To assess the technical feasibility and clinical applicability of SLNB with ICG under near-infrared (NIR) imaging guidance in patients with breast cancer.
Materials and Methods
This prospective single-center study included 30 patients who underwent ICG-guided SLNB between 2023 and 2025. In 24 patients, ICG mapping was combined with technetium-99m radioisotope navigation; in 6 patients, ICG guidance alone was used. The protocol comprised periareolar ICG injection, standardized imaging conditions, and fluorescence-index recording.
Results
The protocol was completed in all 30 patients. Fluorescent visualization of the lymphatic pathway and/or the sentinel lymph node (SLN) was achieved in every case, and no ICG-related adverse reactions were recorded. The mean fluorescence index was 213.0 ± 24.7, the median was 206.0 [192.5–237.2], and the min–max was 180–255.
Conclusion
SLNB with ICG under NIR imaging guidance demonstrated technical feasibility in a prospective single-center cohort. Quantitative fluorescence-index recording may serve as a component of standardizing intraoperative fluorescence guidance.
