Comparison of Indocyanine Green-Guided Fluorescence with Fluorescein Sodium-Based Sentinel Lymph Node Biopsy in Patients with Breast Cancer: A Randomized Controlled Trial

Aakash Chauhan — 2026-01-06

Sentinel lymph node biopsy (SLNB) is now the standard for axillary staging in early breast cancer, replacing axillary lymph node dissection due to lower morbidity while preserving diagnostic accuracy. Dual tracer methods using radioisotopes and blue dyes provide high detection rates but are often limited in resource-constrained settings. Indocyanine green (ICG) and fluorescein sodium have emerged as cost-effective alternatives. This study compared the efficacy, operative efficiency, and cost-effectiveness of ICG versus fluorescein sodium as single-dye tracers for SLNB.

Materials and Method

This study was conducted at AIIMS, New Delhi, between April 2020 and November 2021. Twenty female patients with early breast cancer and clinically node-negative axillae were randomized into two groups: Group A (ICG) and Group B (fluorescein sodium). Standard protocols for dye administration, visualization, and sentinel node dissection were followed. Histopathological analysis was performed for all excised nodes. Data were analyzed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.

Result

Sentinel lymph nodes were identified in all patients with ICG (100%) and in 80% with fluorescein (p=0.47). The mean number of nodes retrieved was similar across groups. Operative time was significantly shorter in the ICG group (24.2 ± 2.56 min) compared with fluorescein (33 ± 4.93 min; p=0.001). However, the mean procedural cost was higher with ICG (INR 14,684.7) versus fluorescein (INR 908.9).

Conclusion

ICG showed higher identification rates and shorter operative time but at greater cost. With affordable near-infrared systems, ICG could serve as a reliable tracer alternative in resource-limited settings.

“Dual Infection of Brucellosis and Abdominal Tuberculosis: An Unusual Cause of Febrile Jaundice

Dr Devmalya Chakravartty — 2026-01-21

Introduction:
Brucellosis and tuberculosis (TB) are important endemic infections in developing countries. Both conditions can present with overlapping systemic and abdominal features, making differentiation challenging. Clinically significant hepatic involvement with jaundice is rare in brucellosis, while abdominal TB often mimics other chronic infections. Co-infection of brucellosis and TB in a single patient is exceedingly rare and may lead to delayed or inappropriate treatment.

Case Presentation:

We report a 22-year-old male with type 2 diabetes mellitus who presented with high-grade fever for 15 days, jaundice for 7 days, right upper abdominal pain, vomiting, and watery diarrhea. Examination revealed icterus and hepatomegaly with right hypochondrial tenderness. Investigations showed thrombocytopenia (platelets 60,000/µl), elevated bilirubin (5.4 mg/dl), transaminitis (SGOT 383 IU/L, SGPT 266 IU/L), and elevated ALP and GGT. Brucella IgM serology was positive, while viral hepatitis, leptospirosis, and scrub typhus serologies were negative. Imaging demonstrated hepatosplenomegaly, bowel wall thickening, enlarged mesenteric lymph nodes, and ascites, highly suggestive of abdominal TB.

Conclusion:
This case emphasizes the diagnostic dilemma posed by overlapping features of brucellosis and TB. In endemic areas, physicians must consider co-infection in atypical presentations such as febrile jaundice. Rational therapy is essential to prevent mismanagement and reduce the risk of drug-resistant tuberculosis.

International Journal of Preventive, Curative & Community Medicine (E-ISSN: 2454-325X)

Comparison of Indocyanine Green-Guided Fluorescence with Fluorescein Sodium-Based Sentinel Lymph Node Biopsy in Patients with Breast Cancer: A Randomized Controlled Trial

Materials and Method

Result

Conclusion

“Dual Infection of Brucellosis and Abdominal Tuberculosis: An Unusual Cause of Febrile Jaundice