Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate

Knackstedt, Rebecca; Couto, Rafael A.; Ko, Jennifer S.; Çakmakoğlu, Çağrı; Wu, Daisy

doi:10.1245/s10434-019-07617-z

Cited by 26 publications

(25 citation statements)

References 47 publications

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“…The authors found that 85.3% of SLNs were detected by a combination of both techniques, 14% by lymphoscintigraphy only, and 0.9% by ICG only. Additionally, the SLN positivity rate (21.4%) was higher than the expected rate based on previous publications [ 11 ]. This higher SLN positivity rate will theoretically reduce the future rate of false negatives.…”

Section: Discussioncontrasting

confidence: 63%

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Near-Infrared Fluorescence Imaging for Sentinel Lymph Node Identification in Melanoma Surgery

Ferri

Montorfano

Bordes

et al. 2021

Cureus

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Although less common than other types of skin cancers, melanoma is accountable for the majority of skin cancer-related deaths. The standard management for patients with clinically negative nodes includes a sentinel lymph node (SLN) biopsy, which is commonly performed using a combination of radioactive tracer (Tc-99) and a blue dye (isosulfan or patent blue). There are numerous drawbacks associated with Tc-99 and blue dyes such as elevated costs, logistical challenges, and anaphylactic reactions among others. In recent years, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has emerged as a safe, effective, less costly, and more convenient alternative for the identification of SLNs in melanoma. We discuss the case of a 51-year-old man with melanoma in his left upper back. Two SLNs in the left axilla were successfully identified using NIR fluorescence. NIR fluorescence with ICG for SLN identification has proven to increase the sensitivity and accuracy when used in combination with lymphoscintigraphy.

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Section: Discussioncontrasting

confidence: 63%

“…Similarly, a prospective trial analyzed 574 patients who underwent lymphoscintigraphy and NIR fluorescence with ICG for SLN detection in primary cutaneous melanoma [ 11 ]. The authors found that 85.3% of SLNs were detected by a combination of both techniques, 14% by lymphoscintigraphy only, and 0.9% by ICG only.…”

Section: Discussionmentioning

confidence: 99%

Near-Infrared Fluorescence Imaging for Sentinel Lymph Node Identification in Melanoma Surgery

Ferri

Montorfano

Bordes

et al. 2021

Cureus

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“…ICG has been used in many surgical interventions as a diagnostic agent (13)(14)(15). The relatively low costs and stability in patients make it a favorable contrast agent.…”

Section: Discussionmentioning

confidence: 99%

Real-time surgical margin assessment using ICG-fluorescence during laparoscopic and robot-assisted resections of colorectal liver metastases

et al. 2020

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Background: Almost a third of the resections in patients with colorectal liver metastases (CRLM) undergoing curative surgery, end up being tumor-margin positive (≤1 mm margin). Near-infrared fluorescent (NIRF) imaging using the fluorescent contrast agent indocyanine green (ICG) has been studied for many different applications. When administered in a relatively low dose (10 mg) 24 hours prior to surgery, ICG accumulated in hepatocytes surrounding the CRLM. This results in the formation of a characteristic fluorescent 'rim' surrounding CRLM when located at the periphery of the liver. By resecting the metastasis with the entire surrounding fluorescent rim, in real-time guided by NIRF imaging, the surgeon can effectively acquire margin-negative (>1 mm) resections. This pilot study aims to describe the surgical technique for using near-infrared fluorescence imaging to assess tumor-margins in vivo in patients with CRLM undergoing laparoscopic or robot-assisted resections.Methods: Out of our institutional database we selected 16 CRLM based on margin-status (R0; n=8, R1; n=8), which were resected by a minimally-invasive approach using ICG-fluorescence. NIRF images acquired during surgery, from both the resection specimen and the wound bed, were analysed for fluorescent signal.We hypothesized that a protruding fluorescent rim at the parenchymal side of the resection specimen could indicate a too close proximity to the tumor and could be predictive for a tumor-positive surgical margin. NIRF images were correlated to final histopathological assessment of the resection margin.Results: All lesions with a NIRF positive resection plane in vivo were reported as having a tumor-positive margin. Lesions that showcased no protruding rim in the wound bed in vivo were diagnosed as having a tumor-negative margin in 88% of cases. A 5-step surgical workflow is described to document the NIRF signal was used assess the resection margin in vivo for future clinical studies. Conclusions:The pilot study shows that image-guided surgery using real-time ICG-fluorescence has the potential to aid surgeons in achieving a tumor-negative margin in minimally invasive liver metastasectomies.The national multi-centre MIMIC-Trial will prospectively study the effect of this technique on surgical tumor-margins (Dutch Trial Register number NL7674).

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“…This field specifically has seen great advancements from 2013 onwards as antibody-mediated TS-FGS paved the way for the clinical translation of tumor-specific imaging agents in recent years [16,17]. In parallel, the dissemination of knowledge and the clinical availability of fluorescence imaging systems [18] resulted in a surge of clinical studies with non-tumor-specific fluorescent dyes [19][20][21]. Technical variables related to optical or fluorescence imaging itself have been described extensively by others (e.g., camera standardization, signal quantification, efficacy of the imaging agent, and trial design) [6,16,22].…”

Section: Introductionmentioning

confidence: 99%

Clinical translation and implementation of optical imaging agents for precision image-guided cancer surgery

Achterberg

Deken

Meijer

et al. 2020

Eur J Nucl Med Mol Imaging

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Introduction The field of tumor-specific fluorescence-guided surgery has seen a significant increase in the development of novel tumor-targeted imaging agents. Studying patient benefit using intraoperative fluorescence-guided imaging for cancer surgery is the final step needed for implementation in standard treatment protocols. Translation into phase III clinical trials can be challenging and time consuming. Recent studies have helped to identify certain waypoints in this transition phase between studying imaging agent efficacy (phase I-II) and proving patient benefit (phase III). Trial initiation Performing these trials outside centers of expertise, thus involving motivated clinicians, training them, and providing feedback on data quality, increases the translatability of imaging agents and the surgical technique. Furthermore, timely formation of a trial team which oversees the translational process is vital. They are responsible for establishing an imaging framework (camera system, imaging protocol, surgical workflow) and clinical framework (disease stage, procedure type, clinical research question) in which the trial is executed. Providing participating clinicians with well-defined protocols with the aim to answer clinically relevant research questions within the context of care is the pinnacle in gathering reliable trial data. Outlook If all these aspects are taken into consideration, tumor-specific fluorescence-guided surgery is expected be of significant value when integrated into the diagnostic work-up, surgical procedure, and follow-up of cancer patients. It is only by involving and collaborating with all stakeholders involved in this process that successful clinical translation can occur. Aim Here, we discuss the challenges faced during this important translational phase and present potential solutions to enable final clinical translation and implementation of imaging agents for image-guided cancer surgery.

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Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate

Cited by 26 publications

References 47 publications

Near-Infrared Fluorescence Imaging for Sentinel Lymph Node Identification in Melanoma Surgery

Near-Infrared Fluorescence Imaging for Sentinel Lymph Node Identification in Melanoma Surgery

Real-time surgical margin assessment using ICG-fluorescence during laparoscopic and robot-assisted resections of colorectal liver metastases

Clinical translation and implementation of optical imaging agents for precision image-guided cancer surgery

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