A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping

Niebling, Maarten G.; Pleijhuis, Rick G.; Bastiaannet, E.; Brouwers, Adrienne H.; Dam, Gooitzen M. van; Hoekstra, Harald J.

doi:10.1016/j.ejso.2015.12.007

Cited by 134 publications

(91 citation statements)

References 45 publications

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“…The high co-registration accuracy between NIR and visible-spectrum images and the high NIR imaging sensitivity under surgical light illumination are key advantages over current FDA-approved instruments used in the operating room. The initial clinical results corroborate results from previous studies [30] and indicate the benefits of using fluorescence properties of ICG for mapping SLNs in patients with cancer.…”

Section: Resultssupporting

confidence: 86%

Bio-inspired imager improves sensitivity in near-infrared fluorescence image-guided surgery

Garcia

Edmiston

York

et al. 2018

Optica

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Image-guided surgery can enhance cancer treatment by decreasing, and ideally eliminating, positive tumor margins and iatrogenic damage to healthy tissue. Current state-of-the-art near-infrared fluorescence imaging systems are bulky and costly, lack sensitivity under surgical illumination, and lack co-registration accuracy between multimodal images. As a result, an overwhelming majority of physicians still rely on their unaided eyes and palpation as the primary sensing modalities for distinguishing cancerous from healthy tissue. Here we introduce an innovative design, comprising an artificial multispectral sensor inspired by the Morpho butterfly’s compound eye, which can significantly improve image-guided surgery. By monolithically integrating spectral tapetal filters with photodetectors, we have realized a single-chip multispectral imager with 1000 × higher sensitivity and 7 × better spatial co-registration accuracy compared to clinical imaging systems in current use. Preclinical and clinical data demonstrate that this technology seamlessly integrates into the surgical workflow while providing surgeons with real-time information on the location of cancerous tissue and sentinel lymph nodes. Due to its low manufacturing cost, our bio-inspired sensor will provide resource-limited hospitals with much-needed technology to enable more accurate value-based health care.

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Section: Resultssupporting

confidence: 86%

Bio-inspired imager improves sensitivity in near-infrared fluorescence image-guided surgery

Garcia

Edmiston

York

et al. 2018

Optica

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“…In non-complicated cases, some surgeons use only the radioisotope. Meta-analyses have demonstrated that this procedure is safe and does not increase the risk for false negativity of the sentinel biopsy [2, 3]. Even the use of the radioisotope by itself, however, requires that a nuclear medicine facility be available, and this is associated with certain disadvantages relating to radioactivity.…”

Section: Introductionmentioning

confidence: 99%

“…Indocyanine green (ICG) could be another substance potentially usable for detecting SLNs [3, 6]. Approved for medicinal uses in 1956, it is commonly used today for diagnosing liver functions, in ophthalmology, cardiology and microcirculation diagnostics.…”

Section: Introductionmentioning

confidence: 99%

Use of indocyanine green and the HyperEye system for detecting sentinel lymph nodes in breast cancer within a population of European patients: a pilot study

Coufal

Fait

2016

World J Surg Onc

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BackgroundCertain studies suggest that using indocyanine green (ICG) could be comparable with using radioisotopes (RI) in detecting sentinel lymph nodes (SLNs) in breast cancer. A number of these studies were performed in Asia. The objective of our pilot study was to evaluate within a European population of breast cancer patients the detection rate of SLNs using ICG and the HyperEye system and the concordance in SLNs detected using this method and the standard method involving RI and a gamma probe.MethodsTen female patients with early-stage breast cancer (Czech Republic) indicated for partial mastectomy and SLN biopsy were subjected to standard application of RI. Before surgery, ICG was administered periareolarly in the amount of 1 ml of 0.5% solution. Sentinel lymph nodes were first detected perioperatively exclusively using ICG fluorescence and the HyperEye device (Mizuho, Japan). Only after removal of all SLNs found in this way was the standard hand-held gamma probe used to detect RI, and any potential additional SLNs not found with ICG were then extirpated.ResultsIn all 10 cases, at least one SLN was successfully detected using ICG. Nevertheless, in five patients, 1–4 additional SLNs were found using the gamma probe. Complete concordance in detecting SLNs therefore occurred in only one half of the cases. Metastases in SLNs were found in a total of two cases. Had we used only ICG for detection, one of these two cases would have been incorrectly evaluated as N0 (ICG false negativity).ConclusionsThe study did not confirm the hypothesis that the use of ICG with the HyperEye system can currently be considered a method fully comparable with using RI and a gamma probe in a population of European patients. Although the detection rate is high, a significantly lower number of SLNs were detected using ICG than using RI (p = 0.03). Thus, there would be a higher probability for false negatives to occur in using SLN biopsy. This is caused mainly by the limited permeability of tissues to fluorescent radiation and the difficulty therefore of detecting nodes located deeper beneath the body’s surface.

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“…Since its introduction in the early 1990s by Donald Morton, SLNB has become a widely accepted staging procedure and has become one of the most important prognostic tools in predicting outcome in cutaneous melanoma 3–7. At time of primary staging, approximately 20 % of melanoma patients are SLNB positive, with a false-negative rate less than 5 % 1,8–10…”

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confidence: 99%

Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients

et al. 2016

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BackgroundSince its introduction, the sentinel lymph node biopsy (SLNB) has become the standard staging procedure in clinical node-negative melanoma patients. A negative SLNB, however, does not guarantee a recurrence-free survival. Insight into metastatic patterns and risk factors for recurrence in SLNB negative melanoma patients can provide patient tailored guidelines.MethodsData concerning melanoma patients who underwent SLNB between 1996 and 2015 in a single center were prospectively collected. Cox regression analyses were used to determine variables associated with overall recurrence and distant first site of recurrence in SLNB-negative patients.ResultsIn 668 patients, SLNBs were performed between 1996 and 2015. Of these patients, 50.4 % were male and 49.6 % female with a median age of 55.2 (range 5.7–88.8) years. Median Breslow thickness was 2.2 (range 0.3–20) mm. The SLNB was positive in 27.8 % of patients. Recurrence rates were 53.2 % in SLNB-positive and 17.9 % in SLNB-negative patients (p < 0.001). For SLNB-negative patients, the site of first recurrence was distant in 58.5 %. Melanoma located in the head and neck region (hazard ratio 4.88, p = 0.003) and increasing Breslow thickness (hazard ratio 1.15, p = 0.013) were predictive for distant first site of recurrence in SLNB-negative patients. SLNB-negative patients with a nodular melanoma and ulceration had a recurrence rate of 43.1 %; the site of recurrence was distant in 64 % of these patients.ConclusionsThe recurrence rates of SLNB-negative nodular ulcerative melanoma patients approach those of SLNB-positive patients. Stringent follow-up is recommended in this subset of patients.

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A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping

Cited by 134 publications

References 45 publications

Bio-inspired imager improves sensitivity in near-infrared fluorescence image-guided surgery

Bio-inspired imager improves sensitivity in near-infrared fluorescence image-guided surgery

Use of indocyanine green and the HyperEye system for detecting sentinel lymph nodes in breast cancer within a population of European patients: a pilot study

Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients

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