Indocyanine Green Fluorescence-Guided Sentinel Lymph Node Biopsy in Breast Cancer Using the MARS Near-Infrared Imaging System: A Prospective Single-Center Feasibility Study

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. Keywords: breast cancer; sentinel lymph node biopsy; indocyanine green; near-infrared imaging; fluorescence lymphography; fluorescence index; axillary staging.