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Mok et al. Mini-invasive Surg 2020;4:26 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.04

Technical Note Open Access

Endoscopic-assisted ICG (EASI) technique for
sentinel lymph node biopsy in breast cancer

Chi Wei Mok , Jun Xian Jeffrey Hing , Spoorthi Sudhakar Shetty , Su-Ming Tan 1,2
1,2
1,2
1,2
1 Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore 529889, Singapore.
2 Singhealth Duke-NUS Breast Centre, Singapore 529889, Singapore.
Correspondence to: Dr. Chi Wei Mok, Division of Breast Surgery, Department of Surgery, Changi General Hospital, 2 Simei Street
3, Singapore 529889, Singapore. E-mail: mok.chi.wei@singhealth.com.sg
How to cite this article: Mok CW, Hing JXJ, Shetty SS, Tan SM. Endoscopic-assisted ICG (EASI) technique for sentinel lymph
node biopsy in breast cancer. Mini-invasive Surg 2020;4:26. http://dx.doi.org/10.20517/2574-1225.2020.04
Received: 5 Jan 2020 First Decision: 9 Mar 2020 Revised: 14 Mar 2020 Accepted: 2 Apr 2020 Published: 11 May 2020

Science Editor: Giulio Belli Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Sentinel lymph node biopsy is currently the standard of care for axillary staging in early breast cancer patients
with no clinical or radiological evidence of axillary lymph node involvement. Novel techniques studied in recent
years include the use indocyanine green (ICG) fluorescence imaging, which was reported in a recent network
meta-analysis to be comparable to standard dual modality in terms of false negative as well as detection rate.
However, there have been no standardized operative methods leading to the underutilization of this modality in
clinical practice. In addition, technical limitations such as the difficulty in tracing ICG flow in obese patients further
restrict the use of ICG fluorescence in sentinel lymph node biopsy. In this article, we describe in detail the use of
the endoscopic-assisted ICG technique in performing sentinel lymph node biopsy, which addresses limitations
associated with conventional use of ICG fluorescence imaging. The technical novelty of this technique lies in the
fact that it has not been previously described in the literature and it allows for the identification of sentinel lymph
nodes with minimal incision and tissue disruption as well.

Keywords: Endoscope, endoscopic, endoscopic-assisted, EASI, indocyanine green, fluorescence, novel technique,
minimally invasive, minimal access

INTRODUCTION
The most widely used technique for sentinel lymph node (SLN) identification is the dual-modality method
involving the injection of technetium-99m-labeled nanocolloid and blue dye into the peritumoral or

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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