Fluorescent Indocyanine Green versus Technetium-99m and Blue Dye for Bilateral SENTinel Lymph Node Detection in Stage I–IIA Cervical Cancer (FluoreSENT): protocol for a non-inferiority study

Baeten, Ilse; Hoogendam, Jacob P.; Braat, Arthur J. A. T.; Veldhuis, Wouter B.; Jonges, G. N.; Jürgenliemk-Schulz, Ina M.; Zweemer, Ronald P.; Gerestein, C.G.

doi:10.1136/bmjopen-2022-061829

Cited by 2 publications

(1 citation statement)

References 44 publications

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“…Indocyanine green (ICG) is radiation-free and allows for the real-time visualization of lymphatic drainage. ICG in combination with methylene blue dye (MBD) for open SLNB has been proven to be safe and feasible ( 5 ) and thus may offer an alternative means to avoiding the issues of the radioisotope and dye methods. Recently, ICG-assisted fluorescence endoscopy, which integrates fluorescence imaging and minimally invasive endoscopy, has been increasingly applied in clinical work.…”

Section: Introductionmentioning

confidence: 99%

Application of fluorescence endoscopy with methylene blue dye and indocyanine green dual-tracer method in sentinel lymph node biopsy for women with breast cancer

Ou¹,

Luo²,

Li³

et al. 2023

Gland Surg

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Background Indocyanine green (ICG) allows for the real-time visualization of lymphatic drainage and provides favorable performance for sentinel lymph node (SLN) mapping. However, the limited ability of tissue penetration of the near-infrared fluorescence of ICG may lead to the failure of lymph node detection in the traditional open approach of sentinel lymph node biopsy (SLNB) for breast cancer, especially in overweight or obese patients. To accurately and quickly detect SLNs, we applied fluorescence endoscopy with a dual-tracer method using ICG and methylene blue dye (MBD) in SLNB for breast cancer. We conducted this study to assess the feasibility and application value of this method in minimally invasive surgery. Methods A total of 117 patients who received dual-tracer injection of ICG and MBD prior to endoscopic SLNB from November 2020 to September 2021 were examined in this study. The number of SLNs identified, the SLN identification rate, the time to identify the first SLN, the procedure duration, and the postoperative morbidity were analyzed. Results Biopsied SLNs could be identified in 116 patients (99.15%) with an average number of 5.12±1.87 per patient. Blue-stained SLNs were found in 99 patients (84.62%) and fluorescent SLNs in 112 patients (95.73%). A total of 34 patients (29.06%) had positive SLNs. In 6 cases (5.13%), the positive SLNs were only stained with ICG fluorescence. In 1 case (0.85%), the positive SLNs were only blue-stained with no fluorescence staining. The mean durations for the identification of the first SLN and endoscopic SLNB were 7.14±6.31 and 37.75±16.94 min, respectively. Upper-limb lymphoedema was observed 5 cases (4.27%) during a median follow-up period of 10 months. Conclusions The fluorescence endoscopy method assisted by dual tracer facilitates SLN detection with a comparatively short procedure duration and low complication rate. This approach could serve as a new method for SLNB for patients with breast cancer.

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Section: Introductionmentioning

confidence: 99%

Application of fluorescence endoscopy with methylene blue dye and indocyanine green dual-tracer method in sentinel lymph node biopsy for women with breast cancer

Ou¹,

Luo²,

Li³

et al. 2023

Gland Surg

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Tumor lesion detection in patients with cervical cancer by indocyanine green near-infrared imaging

Liu

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose To investigate the feasibility and accuracy of near-infrared uorescence (NIRF) imaging for detecting the extent of tumor invasion in cervical cancer using indocyanine green (ICG).Methods: We enrolled 51 patients who were diagnosed with cervical cancer with FIGO stage IB1-IIA2 disease. Patients were administered indocyanine green (ICG) at a dose of 5 mg/kg 24 hours prior to surgery. A customized near-infrared uorescence (NIRF) imaging system was used to identify the extension of tumor invasion when radical hysterectomy specimens were harvested. The relationship between tumor uorescence intensity and clinicopathological characteristics was analyzed.Results: Three patients were without residual tumors after cervical conization, and tumor lesions were identi ed by NIRF imaging in all the remaining 48 patients. The results of NIRF imaging were in agreement with the postoperative pathological ndings in 95.8% of the patients with stromal invasion, 100% of those with surgical margin invasion, 100% of those with parametrial tumor involvement, and 100% of patients with uterine corpus invasion. The mean signal-to-background ratio (SBR) of the cervical tumors was 2.91±1.64, and the SBR was independent of clinicopathological characteristics. Fluorescence microscopy con rmed that ICG uorescence was present in the tumor nests.Conclusions: NIRF imaging enables objective, accurate and safe identi cation of tumor invasion during cervical cancer surgery.

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Fluorescent Indocyanine Green versus Technetium-99m and Blue Dye for Bilateral SENTinel Lymph Node Detection in Stage I–IIA Cervical Cancer (FluoreSENT): protocol for a non-inferiority study

Cited by 2 publications

References 44 publications

Application of fluorescence endoscopy with methylene blue dye and indocyanine green dual-tracer method in sentinel lymph node biopsy for women with breast cancer

Application of fluorescence endoscopy with methylene blue dye and indocyanine green dual-tracer method in sentinel lymph node biopsy for women with breast cancer

Tumor lesion detection in patients with cervical cancer by indocyanine green near-infrared imaging

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