Usefulness and Prospects of Sentinel Lymph Node Biopsy for Patients With Breast Cancer Using the Medical Imaging Projection System

Abstract

BackgroundThe Medical Imaging Projection System (MIPS) projects indocyanine green (ICG) fluorescence images directly on the surgical field using a projection mapping technique. We conducted an observational study of sentinel lymph node (SLN) biopsy using the prototype MIPS; we found a high identification rate. However, the number of SLN-positive cases was small, and the sensitivity could not be evaluated. The aim of this study was to investigate the clinical usefulness of the MIPS assisted ICG fluorescence method using commercially available equipment.MethodsThis was a retrospective observational study. Patients with primary breast cancer who underwent SLN biopsy using the MIPS at Kyoto University Hospital from April to December 2020 were included in the study. The primary endpoints were the identification rate of SLNs and detection of positive SLNs by the MIPS. The secondary endpoint was the number of SLNs excised using the MIPS per patient. We also conducted a questionnaire survey focused on the utility of the MIPS; it involved doctors with an experience in using the MIPS.ResultsSeventy-nine patients (84 procedures) were included in the study. In 60 (71%) procedures, both the radioisotope (RI) method and MIPS were used. At least one SLN could be detected by the MIPS in all the procedures, with an identification rate of 100% (95% confidence interval 95.6–100%). A total of 19 (7%) positive SLNs were removed, which were identifiable by the MIPS. Among 57 patients in whom the MIPS and RI methods were used, there was no positive SLN only identified by the RI method. The results of the questionnaire survey showed that the MIPS enabled the operator and assistant to share the ICG fluorescence image in the surgical field and to communicate with each other easily.ConclusionThe current study demonstrated that the identification rate of SLNs using the MIPS was high, and the MIPS can be used for detecting positive SLNs. It was suggested that the MIPS will be useful in learning SLN biopsy procedures.

Indocyanine green-enhanced thoracoscopic localization of parasternal lymph node: How to do it

“…Near-infrared imaging technology combined with ICG injection has recently been implemented to facilitate navigation during various surgical procedures, including thoracoscopic segmentectomy and sentinel lymph node mapping. [2][3][4][5] We used an echo-guided, intralymph node ICG injection technique to achieve minimal resection, this technique having previously been used for lymphography when treating a chylothorax. 6 In our patient, preoperative computed tomography revealed metastasis in a small parasternal IMN in the second left intercostal space.…”

Image-guided cancer surgery: a narrative review on imaging modalities and emerging nanotechnology strategies

“…There are many commercial devices, FDA-approved, available for NIR fluorescence navigation in laparoscopy, endoscopy, and robotic surgery; an example is the firefly camera integration in the da Vinci Robotic platform [ 26 ]. Of interest, there has recently been reported a medical imaging projection system (MIPS) that provides a continuous real-time projection of ICG fluorescence images directly on the surgical field and overcomes the problem of recurrent dimming of operating room lights [ 27 ].…”

Multimodal Imaging of Target Detection Algorithm under Artificial Intelligence in the Diagnosis of Early Breast Cancer

“…Breast cancer is a malignant tumor with the highest incidence among women [ 1 ]. According to incomplete statistics, the number of new patients of breast cancer in our country takes a percentage of 12.5% in the total number of patients in the world each year, and the mortality rate takes a percentage of 9.7% in the global mortality rate [ 2 ].…”