The impact of temporal variation in indocyanine green administration on tumor identification during fluorescence guided breast surgery.
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: On average, 21% of women in the USA treated with Breast Conserving Surgery (BCS) undergo a second operation because of close positive margins. Tumor identification with fluorescence imaging could improve positive margin rates through demarcating location, size, and invasiveness of tumors. We investigated the technique's diagnostic accuracy in detecting tumors during BCS using intravenous indocyanine green (ICG) and a custom-built fluorescence camera system. METHODS: In this single-center prospective clinical study, 40 recruited BCS patients were sub-categorized into two cohorts. In the first 'enhanced permeability and retention' (EPR) cohort, 0.25 mg/kg ICG was injected ~ 25 min prior to tumor excision, and in the second 'angiography' cohort, ~ 5 min prior to tumor excision. Subsequently, an in-house imaging system was used to image the tumor in situ prior to resection, ex vivo following resection, the resection bed, and during grossing in the histopathology laboratory to compare the technique's diagnostic accuracy between the cohorts. RESULTS: The two cohorts were matched in patient and tumor characteristics. The majority of patients had invasive ductal carcinoma with concomitant ductal carcinoma in situ. Tumor-to-background ratio (TBR) in the angiography cohort was superior to the EPR cohort (TBR = 3.18 ± 1.74 vs 2.10 ± 0.92 respectively, p = 0.023). Tumor detection reached sensitivity and specificity scores of 0.82 and 0.93 for the angiography cohort and 0.66 and 0.90 for the EPR cohort, respectively (p = 0.1051 and p = 0.9099). DISCUSSION: ICG administration timing during the angiography phase compared with the EPR phase improved TBR and diagnostic accuracy. Future work will focus on image pattern analysis and adaptation of the camera system to targeting fluorophores specific to breast cancer.
Date Issued
2021-08-04
Date Acceptance
2021-07-07
Citation
Annals of Surgical Oncology, 2021, 28, pp.5617-5625
ISSN
1068-9265
Publisher
Springer
Start Page
5617
End Page
5625
Journal / Book Title
Annals of Surgical Oncology
Volume
28
Copyright Statement
© Crown 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Cancer Research UK
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
Engineering & Physical Science Research Council (E
National Institute for Health Research
Cymtec Limited, Business & Technology Centre
Imperial College Healthcare NHS Trust- BRC Funding
Wellcome Trust
AstraZeneca
Cancer Research UK
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/34347221
PII: 10.1245/s10434-021-10503-2
Grant Number
RDB04 79560
RD207
25147
II-3A-1109-10038
II-3A-1109-10038
II-LB-0214-20009
EP/V502354/1
II-LS-0511-21004
II-LS-0511-21004
RDB04
208857/Z/17/Z
PO 8300419389
25147
Subjects
Science & Technology
Life Sciences & Biomedicine
Oncology
Surgery
NEAR-INFRARED LIGHT
CONSERVING SURGERY
AMERICAN SOCIETY
CANCER
MARGINS
RADIATION
Humans
Breast Neoplasms
Indocyanine Green
Mastectomy, Segmental
Prospective Studies
Female
Margins of Excision
Oncology & Carcinogenesis
1112 Oncology and Carcinogenesis
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2021-08-04