Evaluating the Use and Feasibility of Indocyanine Green (ICG) as a Beacon of Precision in Sentinel Node Biopsy for Breast Cancer from an Oncoplastic Practice in India

<b>Background:</b> Accurate axillary staging is vital in breast cancer. While dual tracers (Tc-99m + methylene blue dye) are standard for sentinel lymph node biopsy (SLNB), indocyanine green (ICG) offers a cost-effective, safe alternative, especially where nuclear medicine access is limited. Despite growing global use, data from low- and middle-income countries (LMICs) remain scarce. This study presents India's largest cohort using ICG in SLNB. <b>Methods:</b> We analyzed data from 678 breast cancer patients (2013-2023), of whom 609 underwent SLNB. For analysis, patients were grouped into: isotope + blue dye (control), ICG + blue dye (study group), and ICG alone. False-negative rate (FNR) was evaluated in cases where SLNB was followed by axillary lymph node dissection (ALND). All other outcomes were assessed across the SLNB cohort. <b>Results:</b> In upfront surgery, the study group had an identification rate (IR) of 95.6%, an FNR of 5%, and a median node yield of four, compared to the control group (IR 94.1%, FNR 0%, median of three). Post-neoadjuvant systemic therapy (NAST), the study group outperformed the control (IR 92% vs. 88.2%; both FNR 10%), with higher node yield (three vs. two). From 2021, ICG alone showed 100% IR, 0% FNR (upfront), and 95.6% IR (post-NACT), with high median node retrieval. Overall recurrence was 7.8%; loco-regional recurrence was 3.09%. <b>Conclusions:</b> ICG offers high efficacy, safety, and feasibility as a sole tracer, especially in LMICs. Its integration into SLNB and oncoplastic workflows supports its broader adoption as a practical alternative to radioisotopes in breast cancer surgery.