Cost-Effective Analysis of Near Infrared (NIR) vs Radiotracer for Sentinel Lymph Node Biopsy in Breast Cancer

Dip, Fernando; Falcó, Jorge; Montesinos, Manuel R; Fuente, Martin De La; Rosenthal, Raúl J.

doi:10.1016/j.jamcollsurg.2016.08.010

Cited by 4 publications

(2 citation statements)

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“…17,21,34 Also, SLNB by ICG-fluorescence is at least 5 times less expensive than by 99m Tc-nanocolloid. 6,41 First, ICG is an inexpensive pharmaceutical. 2,6,18,21,22,34 Second, as the fluorescent camera can be used for other indications, 17 initial investment costs for equipment can be cost-efficient for hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Sentinel Lymph Node Mapping in Breast Cancer Patients Through Fluorescent Imaging Using Indocyanine Green

et al. 2022

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Objective: The aim was to compare the (sentinel) lymph node detection rate of indocyanine green (ICG)-fluorescent imaging versus standard-of-care 99mTc-nanocoilloid for sentinel lymph node (SLN)-mapping. Background: The current gold standard for axillary staging in patients with breast cancer is sentinel lymph node biopsy (SLNB) using radio-guided surgery using radioisotope technetium (99mTc), sometimes combined with blue dye. A promising alternative is fluorescent imaging using ICG. Methods: In this noninferiority trial, we enrolled 102 consecutive patients with invasive early-stage, clinically node-negative breast cancer. Patients were planned for breast conserving surgery and SLNB between August 2020 and June 2021. The day or morning before surgery, patients were injected with 99mTc-nanocolloid. In each patient, SLNB was first performed using ICG-fluorescent imaging, after which excised lymph nodes were tested with the gamma-probe for 99mTc-uptake ex vivo, and the axilla was checked for residual 99mTc-activity. The detection rate was defined as the proportion of patients in whom at least 1 (S)LN was detected with either tracer. Results: In total, 103 SLNBs were analyzed. The detection rate of ICG-fluorescence was 96.1% [95% confidence interval (95% CI)=90.4%–98.9%] versus 86.4% (95% CI=78.3%–92.4%) for 99mTc-nanocoilloid. The detection rate for pathological lymph nodes was 86.7% (95% CI=59.5%–98.3%) for both ICG and 99mTc-nanocoilloid. A median of 2 lymph nodes were removed. ICG-fluorescent imaging did not increase detection time. No adverse events were observed. Conclusions: ICG-fluorescence showed a higher (S)LN detection rate than 99mTc-nanocoilloid, and equal detection rate for pathological (S)LNs. ICG-fluorescence may be used as a safe and effective alternative to 99mTc-nanocoilloid for SLNB in patients with early-stage breast cancer.

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Section: Discussionmentioning

confidence: 99%

“…Also, SLNB by ICG-fluorescence is at least 5 times less expensive than by 99m Tc-nanocolloid 6,41. First, ICG is an inexpensive pharmaceutical 2,6,18,21,22,34.…”

Section: Discussionmentioning

confidence: 99%