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Pinelli M, Gerardi C, Lettieri E, Maioru M, Marone L, Bertoldi L, Navanteri G, Costantini M, Botti C, Pellini F. Comparison of Indocyanine Green with conventional tracers for sentinel lymph node biopsy in breast cancer: A multidisciplinary evaluation of clinical effectiveness, safety, organizational and economic impact. PLoS One 2024; 19:e0309336. [PMID: 39208241 PMCID: PMC11361597 DOI: 10.1371/journal.pone.0309336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Breast cancer is a global health problem, and sentinel lymph node biopsy (SLNB) is the standard procedure for early-stage breast cancer. Technetium-99 (TC-99), alone or combined with blue dye (BD) are conventional tracers for SLNB, but they have safety, availability, and cost limitations. Indocyanine green (ICG) is an alternative tracer that has been gaining acceptance among healthcare professionals. This study aimed at assessing the clinical and economic value of ICG in hospital settings, using the health technology assessment (HTA) framework. METHODS We conducted a comprehensive evaluation of ICG for SLNB, based on literature sources and data collected from two Italian hospitals that switched from TC-99 to ICG. We analyzed ICG's technical attributes through technology documentation and relevant databases. We performed a systematic literature review of 36 studies to assess the clinical effectiveness and safety of ICG. We obtained organizational insights from clinicians and the clinical engineer involved in the study. We applied Time-Driven Activity-Based Costing (TDABC) and Budget Impact Analysis (BIA) to estimate the economic impact of ICG. The ethical, legal, and social implications of ICG were considered through clinicians' inputs and technology documentation. RESULTS Our results showed that ICG had equivalent or superior clinical effectiveness compared to TC-99 and BD, with minimal adverse events. ICG simplified the surgical pathways, by streamlining procedures, reducing waiting times, and increasing flexibility in scheduling surgeries. Moreover, the TDABC analysis showed significant cost reductions by avoiding the need for pre-operative lymphoscintigraphy and hospitalization, with average savings per single care pathway of around 18% for ICG compared to TC-99. Finally, ICG improved patient experience, and proved regulatory compliance. CONCLUSIONS This study provided strong evidence for ICG's clinical and economic value for SLNB in breast cancer. It ascertained ICG as a valuable alternative to conventional tracers, ensuring clinical effectiveness along with economic and organizational benefits.
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Affiliation(s)
- Maria Pinelli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Chiara Gerardi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Madalina Maioru
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Laura Marone
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Lorenzo Bertoldi
- Oncology Department Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Complex Operative Unit (UOC) Breast Surgery, Breast Unit, Verona, Italy
| | - Giuseppe Navanteri
- Clinical Engineering (IRCCS Istituto Nazionale Tumori Regina Elena—Roma, Italy), Roma, Italy
| | - Maurizio Costantini
- Department Breast Surgery (IRCCS Istituto Nazionale Tumori Regina Elena—Roma, Italy), Roma, Italy
| | - Claudio Botti
- Department Breast Surgery (IRCCS Istituto Nazionale Tumori Regina Elena—Roma, Italy), Roma, Italy
| | - Francesca Pellini
- Oncology Department Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Complex Operative Unit (UOC) Breast Surgery, Breast Unit, Verona, Italy
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Subramonian S, Chopra S, Vidya R. New Alternative Techniques for Sentinel Lymph Node Biopsy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2077. [PMID: 38138180 PMCID: PMC10744367 DOI: 10.3390/medicina59122077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: This review paper highlights the key alternatives to the blue dye/radioisotope method of sentinel lymph node biopsy (SLNB). It analyses the research available on these alternative methods and their outcomes compared to the traditional techniques. Materials and Methods: This review focused on fifteen articles, of which five used indocyanine green (ICG) as a tracer, four used magnetic tracers, one used one-step nucleic acid amplification (OSNA) and Metasin (quantitative reverse transcriptase-polymerase chain reaction), one used the photosensitiser talaporfin sodium, one used sulphur hexafluoride gas microbubbles, one used CT-guided lymphography and two focused on general SLNB technique reviews. Results: Of the 15 papers analysed, the sentinel node detection rates were 69-100% for indocyanine green, 91.67-100% for magnetic tracers, 81% for talaporfin sodium, 9.3-55.2% for sulphur hexafluoride gas microbubbles, 90.5% for CTLG and 82.7-100% for one-step nucleic acid amplification. Conclusions: Indocyanine green fluorescence (ICG) and magnetic tracers have been proven non-inferior to traditional blue dye and isotope regarding SLNB localisation. Further studies are needed to investigate the use of these techniques in conjunction with each other and the possible use of language learning models. Dedicated studies are required to assess cost efficacy and longer-term outcomes.
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Affiliation(s)
| | - Sharat Chopra
- Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport NP20 2UB, UK;
| | - Raghavan Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
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Sakakibara J, Nagashima T, Fujimoto H, Takada M, Ohtsuka M. A review of MRI (CT)/US fusion imaging in treatment of breast cancer. J Med Ultrason (2001) 2023; 50:367-373. [PMID: 37231224 PMCID: PMC10354153 DOI: 10.1007/s10396-023-01316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/15/2023] [Indexed: 05/27/2023]
Abstract
The ultrasound fusion imaging system is a diagnostic device developed in Japan that utilizes ultrasound and magnetic positioning/navigation. A position sensor with a probe reads spatial location information from a magnetic field generator and by synchronously displaying ultrasound images and magnetic resonance (MR)/computed tomography (CT) images in real time. Lesions that are difficult to observe via ultrasonography alone, such as non-mass enhancement, can be identified. Furthermore, lesions that are difficult to identify with ultrasound alone indicated for MRI-guided biopsy under the National Health Insurance Scheme can be identified using ultrasound fusion technology, thereby enabling tissue biopsy to be performed under ultrasound guidance. Using this ultrasound fusion technology, not only non-mass enhancement but also small lesions that are difficult to identify using ultrasound alone can be detected, thus ensuring that a more accurate preoperative imaging diagnosis is established, and leading to safer, more reassuring examinations and surgical procedures. In this paper, we outline the use of this ultrasound fusion technology and fusion techniques in the treatment of breast cancer.
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Affiliation(s)
- Junta Sakakibara
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Takeshi Nagashima
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Hiroshi Fujimoto
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Mamoru Takada
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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Hamdy O, Farouk O, El-Badrawy A, Denewer A, Setit A. Sentinel lymph node biopsy in breast cancer guided by CT lymphography; History, evolution and current applications. Breast Dis 2021; 40:219-225. [PMID: 33935052 DOI: 10.3233/bd-201046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Sentinel lymph node biopsy (SLNB) has efficiently replaced axillary lymph node dissection (ALND) in axillary staging in node-negative breast cancer patients. Dual sentinel lymph node (SLN) localization using radioisotopes and blue dye is the standard technique for SLN mapping. Yet, nuclear medicine facilities are not widely available worldwide. In Japan, Computed tomography lymphography (CTLG) is presented as an SLN mapping technique which was first suggested in 2003 by Suga et al. Multiple subsequent studies confirmed the efficacy of CTLG in SLN mapping in breast cancer. Further applications of the technique followed; such as prediction of SLN metastasis using CTLG, the use of CTLG guided SLN biopsy after neoadjuvant therapy, video-assisted CTLG guided SLN biopsy, the use of real-time virtual sonography with 3-D CTLG, and preoperative localization of the CTLG mapped SLN using either real-time virtual sonography (RVS) guided Indocyanine green (ICG) injection or its marking using liquid charcoal and silver wire and the use of SPIO enhanced magnetic resonance imaging (MRI) for prediction of metastasis in SLNs detected by CTLG. This efficacy and variable applications open the door for conducting wide-scale randomized controlled trials to suggest using CTLG as an efficient alternative for the use of radioisotopes in SLN mapping in breast cancer patients, especially in low and middle-income countries.
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Affiliation(s)
- Omar Hamdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Adel El-Badrawy
- Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Denewer
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Setit
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
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Yuan Q, Hou J, He Y, Liao Y, Zheng L, Wu G. Minimize the extent and morbidity of axillary dissection for node-positive breast cancer patients: implementation of axillary lymph node dissection based on breast lymphatics level. BMC Cancer 2021; 21:293. [PMID: 33740930 PMCID: PMC7980601 DOI: 10.1186/s12885-021-08024-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Breast cancer-related lymphedema (BCRL) is associated with extensive axillary dissection. Axillary lymph node dissection (ALND) based on breast lymphatics level (BLL) was proposed to minimize the surgical extent for node-positive breast cancer patients. Methods A total of 156 consecutive sentinel lymph node-positive (SLN+) or clinically node-positive (cN+) patients underwent sentinel lymph node biopsy (SLNB) with indocyanine green and methylene blue (MB). The SLNs were injected with 0.1 ml MB before removal, and a standard ALND was subsequently performed. The nodes adjacent to the blue-stained axillary lymph nodes from the breast (bALNs) were sent for pathological examination separately by resecting serial tissue every 0.5 cm away from the marginal blue-stained bALNs. Then, a pilot study comparing ALND based on BLL and standard ALND was performed. Results BLL were successfully identified in 20 SLN+ (100%) and 134 cN+ (98.5%) patients. The median number of BLL was four, ranging from three to six. A horizontal line 1.0 cm away from the superior blue-stained bALN and a vertical line 1.0 cm away from the medial blue-stained bALN formed BLL II, III, and IV. All of the additional positive nodes were within 1.0 cm of the blue-stained bALNs. The minimized axillary dissection should resect upwards from the lowest BLL that contains the first confirmed negative blue-stained bALNs. In the pilot study, no patient developed axillary recurrence. Conclusion The ALND surgical procedure based on BLL could minimize the surgical extent for pathological node-positive breast cancer patients and potentially reduce the BCRL rate. Trial registration ChiCTR1800014247. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08024-y.
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Affiliation(s)
- Qianqian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Jinxuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Yukun He
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Yiqian Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Lewei Zheng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China.
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Shimazu K, Miyake T, Tanei T, Naoi Y, Shimoda M, Kagara N, Kim SJ, Noguchi S. Real-Time Visualization of Lymphatic Flow to Sentinel Lymph Nodes by Contrast-Enhanced Ultrasonography with Sonazoid in Patients with Breast Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2634-2640. [PMID: 31371127 DOI: 10.1016/j.ultrasmedbio.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/05/2019] [Indexed: 05/25/2023]
Abstract
Contrast-enhanced ultrasonography with Sonazoid (SNZ) enables real-time visualization, resulting in more precise identification of lymphatic flow to sentinel lymph nodes (SLNs). This study aimed to classify lymphatic drainage patterns to SLNs. Patients (n = 75) with T1-2 N0 M0 breast cancer received a periareolar injection of SNZ to identify SNZ-enhanced SLNs (SNZ-SLNs), followed by SLN biopsy with blue dye. The lymphatic drainage patterns were classified into four types: type A, single lymphatic route/single SLN; type B, multiple lymphatic routes/single SLN; type C, single lymphatic route/multiple SLNs; and type D, multiple lymphatic routes/multiple SLNs. SLNs were successfully identified in all patients using both blue dye and SNZ. The drainage lymphatic pathways identified were as follows: type A in 53 cases (70.7%), type B in seven (9.3%), type C in eight cases (10.7%) and type D in seven (9.3%). SNZ-SLN biopsy is a technically simple method with a 100% identification rate, enabling the real-time visualization of lymphatic flow to SNZ-SLNs.
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Affiliation(s)
- Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tomohiro Miyake
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomonori Tanei
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuto Naoi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masafumi Shimoda
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naofumi Kagara
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seung Jin Kim
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Stouthandel MEJ, Veldeman L, Van Hoof T. Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research. Anat Rec (Hoboken) 2019; 302:1681-1695. [PMID: 31087787 DOI: 10.1002/ar.24143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/21/2019] [Accepted: 03/09/2019] [Indexed: 12/13/2022]
Abstract
This review intends to rekindle efforts to map the lymphatic system by using a more modern approach, based on medical imaging. The structure, function, and pathologies associated with the lymphatic system are first discussed to highlight the need for more accurately mapping the lymphatic system. Next, the need for an interdisciplinary approach, with a central role for the anatomist, to come up with better maps of the lymphatic system is emphasized. The current approaches on lymphatic system research involving medical imaging will be discussed and suggestions will be made for an all-encompassing effort to thoroughly map the entire lymphatic system. A first-hand account of our integration as anatomists in the radiotherapy department is given as an example of interdisciplinary collaboration. From this account, it will become clear that the interdisciplinary collaboration of anatomists in the clinical disciplines involved in lymphatic system research/treatment still holds great promise in terms of improving clinical regimens that are currently being employed. As such, we hope that our fellow anatomists will join us in an interdisciplinary effort to map the lymphatic system, because this could, in a relatively short timeframe, provide improved treatment options for patients with cancer or lymphatic pathologies all over the world. Anat Rec, 302:1681-1695, 2019. © 2019 American Association for Anatomy.
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Affiliation(s)
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Zeng HC, Hu JL, Bai JW, Zhang GJ. Detection of Sentinel Lymph Nodes with Near-Infrared Imaging in Malignancies. Mol Imaging Biol 2019; 21:219-227. [PMID: 29931432 DOI: 10.1007/s11307-018-1237-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Optical molecular imaging, a highly sensitive and noninvasive technique which is simple to operate, inexpensive, and has the real-time capability, is increasingly being used in the diagnosis and treatment of carcinomas. The near-infrared fluorescence dye indocyanine green (ICG) is widely used in optical imaging for the dynamic detection of sentinel lymph nodes (SLNs) in real time improving the detection rate and accuracy. ICG has the advantages of low scattering in tissue absorbance, low auto-fluorescence, and high signal-to-background ratio. The detection rate of axillary sentinel lymph nodes biopsy (SLNB) in breast cancers with ICG was more than 95 %, the false-negative rate was lower than 10 %, and the average detected number ranged from 1.75 to 3.8. The combined use of ICG with nuclein or blue dye resulted in a lower false-negative rate. ICG is also being used for the sentinel node detection in other malignant cancers such as head and neck, gastrointestinal, and gynecological carcinomas. In this article, we provide an overview of numerous studies that used the near-infrared fluorescence imaging to detect the sentinel lymph nodes in breast carcinoma and other malignant cancers. It is expected that with improvements in the optical imaging systems together with the use of a combination of multiple dyes and verification in large clinical trials, optical molecular imaging will become an essential tool for SLN detection and image-guided precise resection.
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Affiliation(s)
- Huan-Cheng Zeng
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- ChangJiang Scholar's Laboratory, Shantou University Medical College, Shantou, Guangdong, China
| | - Jia-Lin Hu
- Chancheng Center Hospital of Foshan, Foshan, Guangdong, China
| | - Jing-Wen Bai
- Xiang'an Hospital, Xiamen University, No. 2000, Xiang'an East Road, Xiamen, 361101, Fujian, China
| | - Guo-Jun Zhang
- ChangJiang Scholar's Laboratory, Shantou University Medical College, Shantou, Guangdong, China.
- Xiang'an Hospital, Xiamen University, No. 2000, Xiang'an East Road, Xiamen, 361101, Fujian, China.
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Mok CW, Tan SM, Zheng Q, Shi L. Network meta-analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer. BJS Open 2019; 3:445-452. [PMID: 31388636 PMCID: PMC6677105 DOI: 10.1002/bjs5.50157] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this network meta‐analysis was to compare the performance of blue dye alone or in combination with radioisotope (technetium‐99m, Tc) with three novel techniques for sentinel lymph node detection in breast cancer: indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast‐enhanced ultrasound imaging (CEUS). Methods PubMed, Embase, the Cochrane Library, China Knowledge Research Integrated Database,
ClinicalTrials.gov and OpenGrey databases were searched up to 31 November 2017, without language restriction. Studies that compared the detection performance of at least one of the novel methods (ICG, SPIO and CEUS) with that of traditional methods (blue dye and/or radioisotope) were included in network meta‐analysis. Results Thirty‐five studies were included. Pooled risk ratios (RRs) for Tc (1·09, 95 per cent c.i. 1·04 to 1·15), ICG (1·12, 1·07 to 1·16) and SPIO (1·09, 1·01 to 1·18) showed statistically better performance in detecting sentinel lymph nodes than blue dye alone. ICG had the lowest false‐negative rate, with a RR of 0·29 (0·16 to 0·54), followed by Tc (RR 0·44, 0·20 to 0·96) and SPIO (RR 0·45, 0·14 to 1·45), with blue dye alone as the reference group. Conclusion SPIO or ICG alone are superior to blue dye alone and comparable to the standard dual‐modality technique of blue dye with Tc.
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Affiliation(s)
- C W Mok
- Division of Breast Surgery, Department of Surgery Changi General Hospital Singapore
| | - S-M Tan
- Division of Breast Surgery, Department of Surgery Changi General Hospital Singapore
| | - Q Zheng
- Singapore Clinical Research Institute Singapore
| | - L Shi
- Singapore Clinical Research Institute Singapore
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A novel somatic mutation of SIN3A detected in breast cancer by whole-exome sequencing enhances cell proliferation through ERα expression. Sci Rep 2018; 8:16000. [PMID: 30375428 PMCID: PMC6207735 DOI: 10.1038/s41598-018-34290-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 10/12/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most frequent tumor in women, and in nearly two-thirds of cases, the tumors express estrogen receptor α (ERα, encoded by ESR1). Here, we performed whole-exome sequencing of 16 breast cancer tissues classified according to ESR1 expression and 12 samples of whole blood, and detected 310 somatic mutations in cancer tissues with high levels of ESR1 expression. Of the somatic mutations validated by a different deep sequencer, a novel nonsense somatic mutation, c.2830 C>T; p.Gln944*, in transcriptional regulator switch-independent 3 family member A (SIN3A) was detected in breast cancer of a patient. Part of the mutant protein localized in the cytoplasm in contrast to the nuclear localization of ERα, and induced a significant increase in ESR1 mRNA. The SIN3A mutation obviously enhanced MCF7 cell proliferation. In tissue sections from the breast cancer patient with the SIN3A c.2830 C>T mutation, cytoplasmic SIN3A localization was detected within the tumor regions where nuclear enlargement was observed. The reduction in SIN3A mRNA correlates with the recurrence of ER-positive breast cancers on Kaplan-Meier plots. These observations reveal that the SIN3A mutation has lost its transcriptional repression function due to its cytoplasmic localization, and that this repression may contribute to the progression of breast cancer.
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Shimazu K, Ito T, Uji K, Miyake T, Aono T, Motomura K, Naoi Y, Shimomura A, Shimoda M, Kagara N, Kim SJ, Noguchi S. Identification of sentinel lymph nodes by contrast-enhanced ultrasonography with Sonazoid in patients with breast cancer: a feasibility study in three hospitals. Cancer Med 2017; 6:1915-1922. [PMID: 28766883 PMCID: PMC5548878 DOI: 10.1002/cam4.1142] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/18/2017] [Accepted: 06/12/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this prospective study was to evaluate the feasibility of periareolar injection of the contrast agent Sonazoid (SNZ) followed by ultrasonography (US) for the identification of sentinel lymph node (SLN) in breast cancer patients with clinically negative node. Patients (n = 100) with T1-2N0M0 breast cancer received a periareolar injection of SNZ followed by US to identify contrast-enhanced SLN. Each contrast-enhanced SLN underwent fine needle aspiration cytology (FNAC) followed by SLN biopsy with a conventional method using blue dye and/or radiocolloid (B/R). In almost all cases, contrast-enhanced lymphatic vessels were clearly visualized by US soon after the periareolar injection of SNZ and the SLNs were easily identified with an identification rate of 98% (98/100) for SNZ and 100% (100/100) for B/R. The number of SLNs identified by SNZ (SNZ-SLN) (mean per patient, 1.52) was significantly lower than that identified by B/R (B/R-SLN) (2.19) (P < 0.0001). Twenty-five patients with positive SLNs had at least one positive SNZ-SLN. On a node-by-node basis, sensitivity, specificity, and accuracy of FNAC for SNZ-SLNs (n = 149) were 33.3%, 99.2%, and 85.9%, respectively. Identification of SLN by periareolar injection of SNZ is a technically simple method with an identification rate as high as 98%. SNZ-SLN thus seems to be a good target for FNAC, but sensitivity of FNAC for SNZ-SLNs needs to be improved.
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Affiliation(s)
- Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Toshikazu Ito
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Kumiko Uji
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Tomohiro Miyake
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Toyokazu Aono
- Department of Breast Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuyoshi Motomura
- Department of Breast Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yasuto Naoi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Atsushi Shimomura
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Masafumi Shimoda
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Naofumi Kagara
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Seung Jin Kim
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
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Burnier P, Niddam J, Bosc R, Hersant B, Meningaud JP. Indocyanine green applications in plastic surgery: A review of the literature. J Plast Reconstr Aesthet Surg 2017; 70:814-827. [PMID: 28292569 DOI: 10.1016/j.bjps.2017.01.020] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 12/12/2016] [Accepted: 01/31/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Use of indocyanine green (ICG) near-infrared fluorescence as a dye to assess tissue vascularization is now well standardized. The aim of this literature review was to review and resume the most recent recommendations for ICG use in its plastic surgery applications. METHODS A systematic literature review was performed using Medline, EMBASE, and PubMed databases to obtain the latest recommendations for ICG in plastic surgery. Inclusion criteria were all articles written in English language that evaluated pre-, intra-, or postoperative ICG applications in surgical procedures usually performed by plastic surgeons. Case reports, reviews, meta-analyses, and experimental studies on animals or cadavers were excluded after title and abstract screening. RESULTS Of the 1389 article titles retrieved, 41 full-text articles met the inclusion criteria. ICG applications in plastic surgery were ICG lymphangiography used in sentinel lymph node mapping for breast cancer and melanoma and in microsurgery for the staging and treatment of secondary chronic lymphedema. The latest updates of ICG angiography in assessing free flaps, pedicled flaps, or large skin paddles were also retrieved. CONCLUSIONS Large prospective studies suggest that ICG lymphography could be used as a single tracer to reliably perform sentinel lymph node biopsy. In the case of cutaneous melanoma, ICG lymphography increases node detection sensitivity and accuracy in conjunction with lymphoscintigraphy. In chronic lymphedema, it is useful for pre- and postoperative staging and intraoperative anatomical location of lymphatic pathways when lymphovenous bypass is indicated. ICG angiography is used intraoperatively to assess free flap anastomosis and design skin paddles and postoperatively to monitor buried flaps. In pedicled perforator flaps or for large skin paddles, intraoperative ICG angiography is strongly correlated with postoperative outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Pierre Burnier
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Jérémy Niddam
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
| | - Romain Bosc
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Barbara Hersant
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Jean-Paul Meningaud
- Department of Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Zhang K, Lu Q, Hua J, Xu J, Wu G. Positive Predictive Value of Mammographic Lymphography in the Evaluation of Patients with Breast Cancer: A Preliminary Study. Acad Radiol 2016; 23:1278-82. [PMID: 27259380 DOI: 10.1016/j.acra.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to investigate the positive predictive value (PPV) of mammographic lymphography (MLG) for assessing malignant breast disease and lymphatic metastasis in patients in a typical clinical setting. MATERIALS AND METHODS Patients who underwent mammography with Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 lesions and had abnormal mammographic findings in the upper-outer quadrant of the breast were enrolled. Next, MLG was performed. A water-soluble agent was subcutaneously injected into the upper-outer periareolar region of the bilateral breast, and mammography was then performed. Morphologic characteristics, including lymphatic vessel development, the presence of lymphatic vessel defects, and dilation, were recorded for evaluation. RESULTS Fifty-one patients with BI-RADS category 4 lesions and 40 patients with BI-RADS category 5 lesions were included in the study. Sixty-one patients were found to have malignant disease, whereas 30 patients were found to have benign disease. Morphologic characteristics were recorded for evaluation. The interobserver agreement was evaluated and was classified as excellent according to kappa analysis. The PPV of MLG characteristics for malignant breast disease and lymphatic metastasis was analyzed by logistic regression, and the presentation of a lymphatic vessel defect was the most predictive characteristic of a malignancy (PPV: 0.89; P value: 0.02) in patients with BI-RADS category 4 lesions. Meanwhile, in patients with malignant breast disease, the PPVs for predicting lymphatic metastasis with lymphatic vessel defect and dilation were 0.50 (P value: 0.02) and 0.67 (P value: <0.01), respectively. CONCLUSION The assessment of morphologic characteristics by MLG has the potential to predict malignant breast disease and lymphatic metastasis.
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Affiliation(s)
- Kebei Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Pudong, No.160, Pujian Road, Pudong, Shanghai, 200127 China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Pudong, No.160, Pujian Road, Pudong, Shanghai, 200127 China
| | - Jia Hua
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Pudong, No.160, Pujian Road, Pudong, Shanghai, 200127 China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Pudong, No.160, Pujian Road, Pudong, Shanghai, 200127 China.
| | - Guangyu Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Pudong, No.160, Pujian Road, Pudong, Shanghai, 200127 China.
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Guenane Y, Gorj M, Nguyen V, Revol M, Mazouz-Dorval S. [Evaluation of green indocyanine interest compared to Technetium in sentinel lymph node detection in breast cancer]. ANN CHIR PLAST ESTH 2016; 61:806-810. [PMID: 27320187 DOI: 10.1016/j.anplas.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/06/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Axillary sentinel lymph node (SN) biopsy by using indocyanine green (ICG) fluorescence for breast cancer is a recent technique. However, compared to Technetium-99m (Tc), which is the reference technique, its efficiency has received little testing. MATERIALS AND METHODS Between December 2013 and January 2014, 40 patients with node-negative breast cancer underwent SN biopsy by injecting sub areolar Tc in preoperative stage and injecting sub areolar ICG in intraoperative stage. SN were previously identified and resected by using ICG coupled with infrared camera. After resection of fluorescent SN, we check its radioactivity with a gamma probe (isotopic method). In case of residual radioactive labeling in the axillary crease, we remove the remaining SN. We have retrospectively analyzed the SN detection concordance rates of these two methods. RESULTS In total we resected 53 SN, among which 48 (90.6%) were indocyanine green positive and 53 (100%) Tc positive. The remaining 5 SN were all ICG negative and Tc positive. Using ICG has not caused any side effect. CONCLUSION SN detection for breast cancer by using ICG fluorescence is a promising, reliable technique which nonetheless requires a degree of expertise before reaching similar results as the Tc technique.
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Affiliation(s)
- Y Guenane
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - M Gorj
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - V Nguyen
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Revol
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - S Mazouz-Dorval
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
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15
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[Focus on methods for detection of sentinel nodes in breast cancer]. ACTA ACUST UNITED AC 2015; 44:35-42. [PMID: 26698220 DOI: 10.1016/j.gyobfe.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
The sentinel node procedure (GS) is the recommended technique for axillary surgical exploration in localized breast cancer with no clinical or radiological lymph node involvement. This surgical technique is based on a dual isotope and colorimetric detection. Although it allows a significant reduction in morbidity compared to axillary dissection (CA), this procedure induces a number of organizational constraints, in particular for the radioisotope injection. Specially for this reason, other GS methods have emerged in recent years, some of which appear promising (detection by fluorescence and magnetic iron). The objective of this paper was to carry out a synthesis of the reference method of detection (radioisotope) GS and analyze the recent literature on new detection methods.
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Ahmed M, Rubio IT, Klaase JM, Douek M. Surgical treatment of nonpalpable primary invasive and in situ breast cancer. Nat Rev Clin Oncol 2015; 12:645-63. [PMID: 26416152 DOI: 10.1038/nrclinonc.2015.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.
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Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Isabel T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands
| | - Michael Douek
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Breast sentinel lymph node navigation with three-dimensional computed tomography-lymphography: a 12-year study. Breast Cancer 2015; 23:456-62. [PMID: 25577514 DOI: 10.1007/s12282-015-0584-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the utility of three-dimensional (3D) computed tomography (CT)-lymphography (LG) breast sentinel lymph node navigation in our institute. PATIENTS AND METHODS Between 2002 and 2013, we preoperatively identified sentinel lymph nodes (SLNs) in 576 clinically node-negative breast cancer patients with T1 and T2 breast cancer using 3D CT-LG method. SLN biopsy (SLNB) was performed in 557 of 576 patients using both the images of 3D CT-LG for guidance and the blue dye method. RESULTS Using 3D CT-LG, SLNs were visualized in 569 (99%) of 576 patients. Of 569 patients, both lymphatic draining ducts and SLNs from the peritumoral and periareolar areas were visualized in 549 (96%) patients. Only SLNs without lymphatic draining ducts were visualized in 20 patients. Drainage lymphatic pathways visualized with 3D CT-LG (549 cases) were classified into four patterns: single route/single SLN (355 cases, 65%), multiple routes/single SLN (59 cases, 11%) single route/multiple SLNs (62 cases, 11%) and multiple routes/multiple SLNs (73 cases, 13%). SLNs were detected in 556 (99.8%) of 557 patients during SLNB. CONCLUSION CT-LG is useful for preoperative visualization of SLNs and breast lymphatic draining routes. This preoperative method should contribute greatly to the easy detection of SLNs during SLNB.
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Kousaka J, Nakano S, Ando T, Tetsuka R, Fujii K, Yoshida M, Shiomi-Mouri Y, Goto M, Imai Y, Imai T, Fukutomi T, Katsuda E, Ishiguchi T, Arai O. Targeted sonography using an image fusion technique for evaluation of incidentally detected breast lesions on chest CT: a pilot study. Breast Cancer 2014; 23:301-9. [PMID: 25373442 DOI: 10.1007/s12282-014-0574-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND With increasing use of computed tomography (CT), incidentally detected breast lesions are being encountered more frequently. The aim of our study was to verify the utility of targeted sonography using an image fusion technique, real-time virtual sonography (RVS) that coordinates real-time sonography images with previously obtained CT images using a magnetic position tracking system, for evaluation of incidentally detected breast lesions on chest CT. METHODS Eleven lesions in 11 women with no history of breast cancer who were referred to our unit for assessment of breast lesions incidentally detected on CT were enrolled in this study. To assess the efficacy of targeted sonography using RVS, we analyzed the frequency of sonographic detection of incidentally detected breast lesions and the difference between sonography- and CT-determined diameters. RESULTS Using RVS guidance, all 11 lesions were sonographically detected. Ten (91 %) of 11 lesions underwent sonography-guided biopsy, yielding a success rate of 90 % (9/10). The remaining sonography-guided biopsy failure lesion required surgical biopsy for definitive diagnosis; this was performed after RVS was used to mark CT imaging information onto the breast surface. Four (36 %) lesions subsequently proved to be malignant. The mean diameters provided by RVS were 14.9 ± 6.7 mm for sonography and 16.8 ± 7.5 mm for CT (p = 0.538). CONCLUSION Using RVS, a sonographic probe was precisely guided to the lesions. Our results suggest that targeted sonography using RVS is a useful technique for identifying incidentally detected breast lesions on chest CT.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Female
- Follow-Up Studies
- Humans
- Image-Guided Biopsy/methods
- Middle Aged
- Neoplasm Staging
- Prognosis
- Radiography, Thoracic/methods
- Retrospective Studies
- Tomography, X-Ray Computed/methods
- Ultrasonography, Interventional/methods
- Ultrasonography, Mammary/methods
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Affiliation(s)
- Junko Kousaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Takahito Ando
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Rie Tetsuka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kimihito Fujii
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Miwa Yoshida
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yukako Shiomi-Mouri
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Manami Goto
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuko Imai
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuneo Imai
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Fukutomi
- Department of Breast Surgery, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minatoku, Tokyo, 108-0073, Japan
| | - Eisuke Katsuda
- Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Osamu Arai
- Medical Systems Engineering Division 2, R&D Section 2 Engineering, R&D Department 1, Hitachi Aloka Medical Ltd, 3-1-1 Higashikoigakubo, Kokubunji, Tokyo, 185-0014, Japan
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Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 2014; 15:e351-62. [PMID: 24988938 DOI: 10.1016/s1470-2045(13)70590-4] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The existing standard for axillary lymph node staging in breast cancer patients with a clinically and radiologically normal axilla is sentinel lymph node biopsy with a radioisotope and blue dye (dual technique). The dependence on radioisotopes means that uptake of the procedure is limited to only about 60% of eligible patients in developed countries and is negligible elsewhere. We did a systematic review to assess three techniques for sentinel lymph node biopsy that are not radioisotope dependent or that refine the existing method: indocyanine green fluorescence, contrast-enhanced ultrasound using microbubbles, and superparamagnetic iron oxide nanoparticles. Our systematic review suggested that these new methods for sentinel lymph node biopsy have clinical potential but give high levels of false-negative results. We could not identify any technique that challenged the existing standard procedure. Further assessment of these techniques against the standard dual technique in randomised trials is needed.
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Affiliation(s)
- Muneer Ahmed
- Department of Research Oncology, King's College London, London, UK; Oncology and Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arnie D Purushotham
- Department of Research Oncology, King's College London, London, UK; Oncology and Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Douek
- Department of Research Oncology, King's College London, London, UK; Oncology and Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Brasseur-Daudruy M, Diguet A, Dacher JN, Verspyck E. Fusion échographie–IRM : une nouvelle approche du cerveau fœtal ? ACTA ACUST UNITED AC 2014; 42:365-8. [DOI: 10.1016/j.gyobfe.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
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Ahmed M, Douek M. What is the clinical relevance of discordance between radioisotope alone and indocynanine green in sentinel lymph node biopsy for breast cancer? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:786. [PMID: 24657137 DOI: 10.1016/j.ejso.2014.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 01/13/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Affiliation(s)
- M Ahmed
- Department of Research Oncology, King's College London, Guy's Hospital Campus, 3rd Floor Bermondsey Wing, Great Maze Pond, London SE1 9RT, UK.
| | - M Douek
- Department of Research Oncology, King's College London, Guy's Hospital Campus, 3rd Floor Bermondsey Wing, Great Maze Pond, London SE1 9RT, UK.
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Chi C, Ye J, Ding H, He D, Huang W, Zhang GJ, Tian J. Use of indocyanine green for detecting the sentinel lymph node in breast cancer patients: from preclinical evaluation to clinical validation. PLoS One 2013; 8:e83927. [PMID: 24358319 PMCID: PMC3865279 DOI: 10.1371/journal.pone.0083927] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 11/10/2013] [Indexed: 02/05/2023] Open
Abstract
Assessment of the sentinel lymph node (SLN) in patients with early stage breast cancer is vital in selecting the appropriate surgical approach. However, the existing methods, including methylene blue and nuclides, possess low efficiency and effectiveness in mapping SLNs, and to a certain extent exert side effects during application. Indocyanine green (ICG), as a fluorescent dye, has been proved reliable usage in SLN detection by several other groups. In this paper, we introduce a novel surgical navigation system to detect SLN with ICG. This system contains two charge-coupled devices (CCD) to simultaneously capture real-time color and fluorescent video images through two different bands. During surgery, surgeons only need to follow the fluorescence display. In addition, the system saves data automatically during surgery enabling surgeons to find the registration point easily according to image recognition algorithms. To test our system, 5 mice and 10 rabbits were used for the preclinical setting and 22 breast cancer patients were utilized for the clinical evaluation in our experiments. The detection rate was 100% and an average of 2.7 SLNs was found in 22 patients. Our results show that the usage of our surgical navigation system with ICG to detect SLNs in breast cancer patients is technically feasible.
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Affiliation(s)
- Chongwei Chi
- Intelligent Medical Research Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jinzuo Ye
- Intelligent Medical Research Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Haolong Ding
- The Breast Center, Cancer Hospital, Shantou University Medical College, Shantou, China
| | - De He
- The Breast Center, Cancer Hospital, Shantou University Medical College, Shantou, China
| | - Wenhe Huang
- The Breast Center, Cancer Hospital, Shantou University Medical College, Shantou, China
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital, Shantou University Medical College, Shantou, China
- * E-mail: (GJZ); (JT)
| | - Jie Tian
- Intelligent Medical Research Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- * E-mail: (GJZ); (JT)
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