A Novel Indocyanine Green Fluorescence‐Guided Video‐Assisted Technique for Sentinel Node Biopsy in Breast Cancer

Sorrentino, Luca; Sartani, A.; Pietropaolo, Giuliana; Bossi, Daniela; Mazzucchelli, Serena; Truffi, Marta; Foschi, Diego; Corsi, Fabio

doi:10.1007/s00268-018-4534-9

Cited by 29 publications

(27 citation statements)

References 38 publications

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“…This study gives insight into ICG with MB as a viable alternative for accurately mapping the lymphatics prior to axillary lymph node surgery. Furthermore, the findings of this study, along with other studies have shown that the use of ICG lymphography is an additional, reliable method to evaluate the upper extremity lymphatic drainage of those patients with clinically evident BCRL [93][94][95][96][97] . ICG lymphography can detect lymphatic channels up to 2 cm deep from the surface of the skin and can show lymphatic channels, lymphatic valves, and lymphatic flow immediately after injection of ICG [98] .…”

Section: Stagementioning

confidence: 52%

Lymphedema after treatment of breast cancer: a comprehensive review

Ayre¹,

Parker²

2019

JUMD

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Lymphedema is a chronic and morbid complication that can result from breast cancer treatment involving surgery and/or radiation therapy. Breast cancer related lymphedema (BCRL) can result in functional and psychological problems that can affect a patient's quality of life. Lymphedema is a pathologic condition of the lymphatic system in which protein-containing fluid accumulates in the interstitial tissue leading to tissue inflammation, fibrosis, and adipose hypertrophy. Clinical manifestations of lymphedema include swelling, induration, skin changes, and decreased functionality of the affected limb. A common risk factor associated with BCRL is the management of the axilla. Advances in research have shown sentinel lymph biopsy to be equally effective as axillary lymph node dissection in staging the axilla, in appropriate cases. In addition, with breast-conserving therapy it has been shown that radiation therapy also increases the risk of BCRL. Overall, approximately 1 in 6 women treated for breast cancer will develop lymphedema within months to years after diagnosis and treatment. Lymphedema is a progressive disease with a subclinical phase that can last for years before becoming clinically evident. While management of breast cancer has improved, it is important that we develop a coordinated and standardized approach to better diagnose, assess, and manage BCRL. This includes patient education, a thorough physical examination, access to confirmatory testing when necessary, a conservative multimodality treatment plan that includes compression and decongestive therapy, and being able to offer operative management when conservative management is ineffective. METHODSWe performed PubMed/MEDLINE and Cochrane searches of the English-language literature. Studies of all dates were included to provide adequate background as well as to capture new studies that have emerged in the past 5 years. General keywords used for this search were lymphedema, breast-cancer related lymphedema, decongestive lymphatic

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Section: Stagementioning

confidence: 52%

Lymphedema after treatment of breast cancer: a comprehensive review

Ayre¹,

Parker²

2019

JUMD

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“…The limitations of both dye and radioisotope (RI) mapping has led to the development of new contrast agents for sentinel node biopsy, such as magnetic 19,20 and fluorescence imaging approaches. [21][22][23][24][25][26][27][28][29][30][31] Fluorescence imaging was first used clinically in the 1940 s, when fluorescein was used in the presence of ultraviolet (UV) light to delineate suspected brain tumors. 32 Fluorescence imaging with currently approved exogenous fluorophores is a safe, non-ionizing and rapid technique, with macroscopic visualization capabilities to facilitate surgical guidance, as illustrated in Fig.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery

et al. 2020

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Introduction Conventional methods for axillary sentinel lymph node biopsy (SLNB) are fraught with complications such as allergic reactions, skin tattooing, radiation, and limitations on infrastructure. A novel technique has been developed for lymphatic mapping utilizing fluorescence imaging. This meta-analysis aims to compare the gold standard blue dye and radioisotope (BD-RI) technique with fluorescence-guided SLNB using indocyanine green (ICG). Methods This study was registered with PROSPERO (CRD42019129224). The MEDLINE, EMBASE, Scopus, and Web of Science databases were searched using the Medical Subject Heading (MESH) terms ‘Surgery’ AND ‘Lymph node’ AND ‘Near infrared fluorescence’ AND ‘Indocyanine green’. Studies containing raw data on the sentinel node identification rate in breast cancer surgery were included. A heterogeneity test (using Cochran’s Q) determined the use of fixed- or random-effects models for pooled odds ratios (OR). Results Overall, 1748 studies were screened, of which 10 met the inclusion criteria for meta-analysis. ICG was equivalent to radioisotope (RI) at sentinel node identification (OR 2.58, 95% confidence interval [CI] 0.35–19.08, p < 0.05) but superior to blue dye (BD) (OR 9.07, 95% CI 6.73–12.23, p < 0.05). Furthermore, ICG was superior to the gold standard BD-RI technique (OR 4.22, 95% CI 2.17–8.20, p < 0.001). Conclusion Fluorescence imaging for axillary sentinel node identification with ICG is equivalent to the single technique using RI, and superior to the dual technique (RI-BD) and single technique with BD. Hospitals using RI and/or BD could consider changing their practice to ICG given the comparable efficacy and improved safety profile, as well as the lesser burden on hospital infrastructure.

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“…With OLLI, nuclear medicine employees and lymphoscintigraphy are not required for detection of SNL’s by ICG. OLLI is likely to cost less than ROLL as ICG only costs 65 euros, excluding tax per patient . Spillage of fluorescent dye was already reported in previous study .…”

mentioning

confidence: 56%

Occult lesion localization by indocyanine green fluorescence for nonpalpable breast cancer

Francini

Rathat

Manna³

et al. 2020

Breast J

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Funding informationMontpellier-Reine Breast Cancer Association.One third of operated breast cancers are clinically occult. 1 Nonpalpable breast cancers (NPBC) require accurate intraoperative guidance to achieve complete tumor removal. 1 Incomplete removal of lesions increases the rate of reexcision, worsening patient's discomfort, and cosmetic outcomes. 1 Localization techniques suffer from various limitations. Indocyanine green (ICG) fluorescence is commonly used for intraoperative identification of sentinel lymph nodes (SLN). 2 Its pertinence for NPBC is still underestimated.Darkness required in surgery room with available cameras has been a limitation for its use. We evaluated ICG method for NPBC localization, guided by a probe in ambient light, inspired by radioguided occult lesion localization (ROLL).We included ten patients scheduled for routine conserving surgery for NPBC, from October 2017 to July 2018 in our Breast Surgery Department. Nodular mass was assessed by mammography and ultra sound (US). Exclusion criteria were palpable tumor, advanced stage of disease requiring neo-adjuvant therapy, and hypersensitivity to iodine. Patients with bilateral tumor were randomized to evaluate this technique in one breast. Study was approved by Ethics Committee (NCT03313908). National Agency for Safety of Medicines (ANSM) authorized this clinical trial on medicinal product for human use (Reference: 170405A-13). Identifier on Clinical Trials. gov is NCT03313908. Written consent was signed after detailed written information. The day preceding surgery, injection of 0.2 mL (10 MBq) of 99mTc-labeled rhenium sulfide (Nanocis1, IBA molecular France) was performed by a radiologist as described in ROLL. 3 This injection is done the day before surgery to avoid delays in the operating room in case of difficulties in radiology or nuclear medicine departments. On the day of surgery, under general anesthesia, 0.2-0.8 mL (0.5-2 mg) of ICG was injected close to NPBC, by a radiologist under US guidance. Tumor was spotted by two methods: isotope and fluorescence. For isotope localization, common gamma probe (Gamma sud II/Clerad: GS 5002) with collimator was used, like classical ROLL. For fluorescence localization, we used new handheld dual-fluorescence probe (Europrobe 3, Eurorad SA) operating in ambient light, commercially available but mainly used for lymph node detection. Probes defined "hot spot'' in area of maximum radioactivity or fluorescence corresponding to the site of lesion. Localization of lesion was drawn on skin with marker pen for both methods (Figure 1). Distance between markers was measured. Surgeons performed conserving breast surgery following standard procedure, using ROLL. Primary end point was to determine reliability of ICG fluorescence in locating NPBC, estimated by distance between fluorescence hot spot and tumor localization on histologic specimen, compared to isotope hot spot, identified by wires (Figure 2). Secondary end points were distance between hot spot marks on skin, evaluation of technical feasibilit...

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A Novel Indocyanine Green Fluorescence‐Guided Video‐Assisted Technique for Sentinel Node Biopsy in Breast Cancer

Abstract: Video-assisted ICG-guided technique is a feasible and surgeon-friendly method for SLN biopsy, with equivalent efficacy compared to RI, providing an accurate staging of the axilla.

Cited by 29 publications

References 38 publications

Lymphedema after treatment of breast cancer: a comprehensive review

Lymphedema after treatment of breast cancer: a comprehensive review

Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery

Occult lesion localization by indocyanine green fluorescence for nonpalpable breast cancer

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