Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis

Goonawardena, Janindu; Yong, Charles; Law, Michael

doi:10.1016/j.amjsurg.2020.02.001

Cited by 45 publications

(52 citation statements)

References 36 publications

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“…Recent meta-analysis showed that ICG has SLN detection rate from 81.9% to 100% and sensitivity from 65.2% to 100%. No statistical difference in detection rate and sensitivity was found between ICG combined with RI tracer and ICG alone [17]. The key factor in evaluating the quality of SLNB is the falsenegative rate.…”

Section: Discussionmentioning

confidence: 81%

Real-time in situ navigation system with indocyanine green fluorescence for sentinel lymph node biopsy in patients with breast cancer

Wang

Yang

Liu

et al. 2020

Preprint

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Background: The naked-eye invisibility of indocyanine green fluorescence limits the application of near-infrared fluorescence imaging (NIR) systems for real-time navigation during sentinel lymph node biopsy (SLNB) in patients with breast cancer undergoing surgery. This study aims to evaluate the effectiveness and safety of a novel NIR system in visualizing indocyanine green fluorescence images in the surgical field and the application value of combined methylene blue (MB) and the novel NIR system in SLNB. Methods: Sixty patients with clinical node-negative breast cancer received indocyanine green (ICG) and MB as tracers. Two NIR system instruments, namely, lymphatic fluorescence imaging system (LFIS) designed by the University of Science and Technology of China and vascular imager by Langfang Mingde Medical Biotechnology Co., Ltd. (Langfang vascular imager), were used as navigation assistance to locate sentinel lymph nodes (SLNs). Excising the lymph nodes developed by both MB and ICG by two NIR systems or palpably suspicious as SLNs and undergoing rapid pathological examination. Results: Both instruments exhibited 95% (57/60) success for real-time lymphatic fluorescent images. A total of 186 SLNs were identified, of which two were pathologically confirmed as lacking any lymph node tissue. SLN identification rate was 100% (184/184) for MB plus LFIS and 86.96% (160/184) for MB alone. The average number of SLNs identified by LFIS combined with MB was 3 (range of 1–8), which was significantly higher than that by MB alone at 2 (range 1–7) (P<0.05). Conclusion: LFIS effectively detects SLNs in breast cancer, projects the fluorescence signals during surgery, and provides a continuous surgical navigation system without the need for a remote monitor. The ICG method navigated by combined LFIS and MB may be a promising alternative tracer for radioisotope in SLN mapping.

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Section: Discussionmentioning

confidence: 81%

Real-time in situ navigation system with indocyanine green fluorescence for sentinel lymph node biopsy in patients with breast cancer

Wang

Yang

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Recent meta-analysis showed that ICG has SLN detection rate from 81.9-100% and sensitivity from 65.2-100%. No statistical difference in detection rate and sensitivity was found between ICG combined with RI tracer and ICG alone [17]. The key factor in evaluating the quality of SLNB is the false-negative rate.…”

Section: Discussionmentioning

confidence: 81%

Real-time in Situ Navigation System with Indocyanine Green Fluorescence for Sentinel Lymph Node Biopsy in Patients with Breast Cancer

Wang

Yang

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The naked-eye invisibility of indocyanine green fluorescence limits the application of near-infrared fluorescence imaging (NIR) systems for real-time navigation during sentinel lymph node biopsy (SLNB) in patients with breast cancer undergoing surgery. This study aims to evaluate the effectiveness and safety of a novel NIR system in visualizing indocyanine green fluorescence images in the surgical field and the application value of combined methylene blue (MB) and the novel NIR system in SLNB.Methods: Sixty patients with clinical node-negative breast cancer received indocyanine green (ICG) and MB as tracers. Two NIR system instruments, namely, lymphatic fluorescence imaging system (LFIS) designed by the University of Science and Technology of China and vascular imager by Langfang Mingde Medical Biotechnology Co., Ltd. (Langfang vascular imager), were used as navigation assistance to locate sentinel lymph nodes (SLNs). Excising the lymph nodes developed by both MB and ICG by two NIR systems or palpably suspicious as SLNs and undergoing rapid pathological examination.Results: Both instruments exhibited 95% (57/60) success for real-time lymphatic fluorescent images. A total of 186 SLNs were identified, of which two were pathologically confirmed as lacking any lymph node tissue. SLN identification rate was 100% (184/184) for MB plus LFIS and 86.96% (160/184) for MB alone. The median number of SLNs identified by LFIS combined with MB was 3 (range of 1–8), which was significantly higher than that by MB alone at 2 (range 1–7) (P<0.05).Conclusion: LFIS effectively detects SLNs in breast cancer, projects the fluorescence signals during surgery, and provides a continuous surgical navigation system without the need for a remote monitor. The ICG method navigated by combined LFIS and MB may be a promising alternative tracer for radioisotope in SLN mapping.

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“…However, we have to serve our best to cancer patients. Fluorescent imaging is a competing technology challenging the standard procedure of SLNB with radioactivity in centers without accessibility to lymphoscintigraphy with the limited data in the setting of NAC 1 . The most controversial issue in regard to SLNB after NAC is FNR.…”

Section: Resultsmentioning

confidence: 99%

Breast cancer surgery under the shadow of COVID‐19: Quest for optimal axillary management after neo‐adjuvant chemotherapy

Tasdoven

Çakmak

2020

Breast J

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Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis

Cited by 45 publications

References 36 publications

Real-time in situ navigation system with indocyanine green fluorescence for sentinel lymph node biopsy in patients with breast cancer

Real-time in situ navigation system with indocyanine green fluorescence for sentinel lymph node biopsy in patients with breast cancer

Real-time in Situ Navigation System with Indocyanine Green Fluorescence for Sentinel Lymph Node Biopsy in Patients with Breast Cancer

Breast cancer surgery under the shadow of COVID‐19: Quest for optimal axillary management after neo‐adjuvant chemotherapy

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