to evaluate safe needle biopsy access, with potential subsequent ultrasound- guided needle biopsy. B. E. Dogan, MD Reference 1. Dogan BE, Dyden MJ, Wei W, et al. Sonography and sonographically guided needle biopsy of internal mammary nodes in staging of patients with breast cancer. AJR Am J Roentgenol. 2015;205: 905-911. SENTINEL NODE BIOPSY Evaluation of the Clinical Utility of the ICG Fluorescence Method Compared with the Radioisotope Method for Sentinel Lymph Node Biopsy in Breast Cancer Sugie T, Kinoshita T, Masuda N, et al (Kansai Med Univ, Hirakata, Japan; Natl Cancer Ctr Hosp, Tokyo, Japan; Osaka Natl Hosp, Japan; et al) Ann Surg Oncol 23:44-50, 2016 Purpose.dThis study compared the clinical utility of indocyanine green (ICG) fluorescence and radioiso- tope (RI) for sentinel lymph node (SLN) detection in breast cancer. Methods.dWomen with node- negative breast cancer underwent SLN biopsy using ICG fluorescence and RI. The primary end point was the sensitivity of ICG fluorescence compared with RI in the patients with tumor-positive SLNs. Secondary end points included detection rates for SLN, the additive effect of ICG fluores- cence to RI, signature of positive SLNs according to tier, and adverse events related to ICG administration. Results.dA total of 847 women with clinical node-negative breast can- cer underwent SLN biopsy, and 821 patients were included in the per- protocol analysis. SLN mapping was performed using ICG fluorescence and RI. The overall detection of SLNs using ICG fluorescence was identical to RI (97.2 vs. 97.0 %, P ¼ 0.88), and the combination of both methods achieved a significant improvement compared with RI alone (99.8 vs. 97.0 %, P < 0.001). The detection rate for tumor-positive SLN was 93.3 % for ICG fluorescence and 90.0 % for RI, and the sensitivity of the ICG fluo- rescence method was 95.7 % (95% CI 91.3e98.3, P ¼ 0.11). The additional use of ICG significantly improved pos- itive SLN detection for RI (97.2 vs. 90.0 %, P < 0.001). There were no seri- ous adverse events related to hypersen- sitivity to ICG. Conclusions.dThe ICG fluores- cence method may be an acceptable alternative to SLN detection using RI in breast cancer. Despite the introduction of SLN biopsy for axillary staging in clini- cally node-negative breast cancer almost two decades ago, there is per- sistent variation in the details of the methodology and an urgent need to standardize these techniques to maxi- mize performance parameters and better define the role of alternative tracer agents. 1 Methods for SLN localization continue to rely on tech- niques employing blue dye and RI, with the combination representing the optimal standard of care. Non- randomized single-institution and multi-institutional validation studies involving more than 10 000 patients revealed high rates of identification of SLNs (>95%), with false-negative rates averaging 8.4%. 2 Subsequent randomized trials of dual localization techniques confirmed high sensitivity (>90%) and negative predictive val- ues (>97%), with a false-negative rate of 9.8% seen in the largest trial, the National Surgical Adjuvant Breast and Bowel Project B-32 study. 3 In the past 4 to 5 years, surgeons have increasingly chosen to omit the rou- tine use of blue dye when a strong radioactive signal is detected on per- cutaneous interrogation of the axilla. This trend has been encouraged by increased reporting of adverse reac- tions to blue dye following the issu- ance of a drug safety update by the 198 Breast Diseases: A Year Book Ò Quarterly Vol 27 No 3 2016