Indocyanine green in diagnostics and reconstructive surgery for breast cancer

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OBJECTIVE

To analyze the efficacy of sentinel lymph node detection using indocyanine green (ICG) in breast cancer.

MATERIAL AND METHODS

The study included 153 breast cancer patients (stage 0-I-II-III, cN0 or cN1-ycN0) between October 2022 and April 2023. All patients underwent sentinel lymph node biopsy using ICG.

RESULTS

Sentinel lymph node was successfully detected in 150 cases out of 153 ICG injections. Optimal period between ICG injection and its accumulation in regional lymph nodes was 10—12 min. Sensitivity of sentinel lymph node detection was 98.0% that exceeds the approximate value of radioisotope method adopted as a standard (96.9—97.2%), as well as sensitivity of proprietary blue dye (90.6—95.0%). Specificity of this method was 100%.

CONCLUSION

The authors’ experience regarding application of indocyanine green is consistent with numerous world statistics and proves the possibility of its effective use for sentinel lymph node biopsy. It is necessary to introduce this diagnostic method as a leading or alternative method for analysis of sentinel lymph node in national clinical guidelines.

Keywords:

indocyanine green

ICG

breast cancer

reconstructive surgery

Authors:

A.D. Zikiryakhodzhaev

Herzen Moscow Oncology Research Institute;
People’s Friendship University of Russia;
I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-7141-2502

M.V. Starkova

P.A. Herzen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Center of the Ministry of Health of Russia

SPIN RSCI: 7758-8806
Scopus AuthorID: 57216884512
ORCID: 0000-0003-4141-8414

V.O. Timoshkin

Herzen Moscow Oncology Research Institute

ORCID: 0000-0002-2490-9353

Received:

05.06.2023

Accepted:

12.07.2023

List of references:

Kaprin AD, Starinskij VV, Shahzadova AO. Zlokachestvennye novoobrazovaniya v Rossii v 2021 godu (zabolevaemost’ i smertnost’). M.: MNIOI im. P.A. Gercena — filial FGBU «NMIC radiologii» Minzdrava Rossii; 2022. (In Russ.).
Klinicheskie rekomendacii. Rak molochnoj zhelezy. 2021. Odobreno na zasedanii nauchno-prakticheskogo soveta Ministerstva zdravoohraneniya Rossijskoj Federacii (protokol ot 25.12.20 №17-4/4884). Accessed July 09, 2023. (In Russ.). https://oncology-association.ru/wp-content/uploads/2021/02/rak-molochnoj-zhelezy-2021.pdf
Breast Cancer. NCCN Guidelines. Version 4.2020. NCCN. 21.06.2020. Accessed July 09, 2023. https://clck.yandex.ru/redir/nWO_r1F33ck?
Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, Weaver DL, Miller BJ, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, Mammolito DM, McCready DR, Mamounas EP, Costantino JP, Wolmark N; National Surgical Adjuvant Breast and Bowel Project. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: Results from the NSABP B-32 randomised phase III trial. Lancet Oncology. 2007;8(10):881-888. https://doi.org/10.1016/S1470-2045(07)70278-4
Pellini F, Bertoldi L, Deguidi G. The use of indocyanine green as the only tracer for the identification of the sentinel lymph node in breast cancer: safety and feasibility. Gland Surgery. 2022;11(7):1139-1147. https://doi.org/10.21037/gs-21-609
Xiong L, Gazyakan E, Yang W. Indocyanine green fluorescence-guided sentinel node biopsy: a meta-analysis on detection rate and diagnostic performance. European Journal of Surgical Oncology. 2014;40(7):843-849. https://doi.org/10.1016/j.ejso.2014.02.228
Sabapathy V, Mentam J, Jacob PM, Kumar S. Noninvasive Optical Imaging and In Vivo Cell Tracking of Indocyanine Green Labeled Human Stem Cells Transplanted at Superficial or In-Depth Tissue of SCID Mice. Stem Cells International. 2015;606415. https://doi.org/10.1155/2015/606415
Black K,Tang R, Egbulefu C S-W, Tsen DW, Akers J, Achilefu S. Fluorescence Cancer Imaging. Comprehensive Supramolecular Chemistry II. 2017;469-490. https://doi.org/10.1016/B978-0-12-409547-2.12619-8
Coibion M, Olivier F, Courtois A. A Randomized Prospective Non-Inferiority Trial of Sentinel Lymph Node Biopsy in Early Breast Cancer: Blue Dye Compared with Indocyanine Green Fluorescence Tracer. Cancers. 2022;14(4):888. https://doi.org/10.3390/cancers14040888
Goonawardena J, Yong C, Law M. Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis. American Journal of Surgery. 2020;220(3):665-676. https://doi.org/10.1016/j.amjsurg.2020.02.001
Valente SA, Al-Hilli Z, Radford DM. Near infrared fluorescent lymph node mapping with indocyanine green in breast cancer patients: a prospective trial. Journal of the American College of Surgeons. 2019;228:672-678. https://doi.org/10.1016/j.jamcollsurg.2018.12.001
Starkova MV, Zikiryakhodzhaev AD, Grushina TI. Diagnostics of sentinel lymph node using radioisotope colloid. Mistakes and opportunities. Vestnik soveta molodyh uchenyh i specialistov Chelyabinskoj oblasti. 2018;2(1-20):92-93. (In Russ.).
Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S, Cardoso F; ESMO Guidelines Working Group. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2013;24 (suppl 6):7-23. https://doi.org/10.1093/annonc/mdt284
Jinno H, Inokuchi M, Ito T, Kitamura K, Kutomi G, Sakai T, Kijima Y, Wada N, Ito Y, Mukai H. The Japanese Breast Cancer Society clinical practice guideline for surgical treatment of breast cancer, 2015 edition. Breast Cancer. 2016;23:367-377. https://doi.org/10.1007/s12282-016-0671-x
Sugie T, Ikeda T, Kawaguchi A, Shimizu A, Toi M. Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer: a meta-analysis. International Journal of Clinical Oncology. 2017;22:11-17. https://doi.org/10.1007/s10147-016-1064-z
Olivier F, Courtois A, Jossa V, Bruck G, Aouachria S, Coibion M, Jerusalem G. Sentinel lymph node mapping with patent blue dye in patients with breast cancer: a retrospective single institution study. Gland Surgery. 2021;10(9):2600-2607. https://doi.org/10.21037/gs-21-415
Dixon JM, Cartlidge CWJ. Twenty-five years of change in the management of the axilla in breast cancer. Breast Journal. 2020;26:22-26. https://doi.org/10.1111/tbj.13720
Kim MK, Park HS, Kim JY, Kim S, Nam S, Park S, Kim SI. The clinical implication of the number of lymph nodes harvested during sentinel lymph node biopsy and its effects on survival outcome in patients with node-negative breast cancer. American Journal of Surgery. 2017;214(4):726-32. https://doi.org/10.1016/j.amjsurg.2016.10.019
Pellini F, Bertoldi L, Deguidi G, Perusi N, Caldana M, De Flaviis M, Di Paolo S, Mirandola S, Tombolan V, Zambelli Sopalu S, Invento A. The use of indocyanine green as the only tracer for the identification of the sentinel lymph node in breast cancer: safety and feasibility times. Gland Surgery. 2022;11(7):1139-1147. https://doi.org/10.21037/gs-21-609
Ngô C, Sharifzadehgan S, Lecurieux-Lafayette C, Belhouari H, Rousseau D, Bonsang-Kitzis H, Crouillebois L, Balaya V, Oudard S, Lécuru F, Elaidi RT. Indocyanine green for sentinel lymph node detection in early breast cancer: Prospective evaluation of detection rate and toxicity-The FLUOBREAST trial. Breast Journal. 2020;26(12):2357-2363. https://doi.org/10.1111/tbj.14100

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