Indocyanine green fluorescence-guided lumpectomy of nonpalpable breast cancer versus wire-guided excision: A randomized clinical trial

Meng, Tong; Guo, Wenhui

doi:10.1111/tbj.13207

Cited by 10 publications

(36 citation statements)

References 9 publications

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“…In total, 24 RCTs fulfilled our inclusion criteria and were included in this systematic review and NMAs ( Fig. 1 ) [ 16 , 27 , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] ]. Of the 24 RCTs included in this analysis, almost 40.0% were conducted in European surgical research institutions (37.5%, 9/24).…”

Section: Resultsmentioning

confidence: 99%

“…There was low to moderate risk of bias among the included RCTs: Overall, 10 of the included RCTs had low-risk of bias (41.7%) [ 27 , 42 , 45 , 50 , 51 , 53 , 54 , 57 , 61 , 62 ], 12 of the RCTs included some concerns for bias (60.0%) [ 16 , 24 , 41 , 44 , [47] , [48] , [49] , 52 , 55 , [58] , [59] , [60] ], while 2 RCTs were considered high-risk of bias (10.0%) [ 46 , 56 ]. Risk of bias assessment is illustrated in the Supplementary Appendix 1 .O.…”

Section: Resultsmentioning

confidence: 99%

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Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

et al. 2022

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Mammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of nonpalpable breast cancer localization. Methods: A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. Results: 24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079-0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069-0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050-0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001-0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods. Conclusion: USGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for reoperation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

et al. 2022

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“…In a previous case report on non-palpable breast lesion localization, ICG-F guided occult lesion localization (IFOLL) demonstrated successful surgical excision indicating that IFOLL was a clinically acceptable procedure 8 . A randomized clinical trial using ICG-F localization for non-palpable lesions showed that the rate of clear margins was significantly high (87.5% in the ICG-F group vs. 63.3% in the wire localization group, p = 0.026) 10 . Another study on the excision of non-palpable breast cancer using ICG-F confirmed localization of 100% and a safe margin at about 95% 9 .…”

Section: Discussionmentioning

confidence: 99%

“…There have been some reports of excisions which injected ICG-F into the intra-tumor for non-palpable lesions of breast cancer. Localized excisions using ICG-F have been shown to be possible as an alternative to previous existing methods 8 – 10 . However, a study of excisions using sono-guided peritumor ICG-F injections for breast cancer has yet to be published.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of localization using indocyanine green fluorescence in breast conserving surgery: a prospective study

Lee

Kim

Han

et al. 2021

Sci Rep

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We investigated localization and safe resection margins for breast cancer patients undergoing breast conserving surgery (BCS) using ultrasound-guided indocyanine green fluorescence (ICG-F) marking. From April 2016 to March 2019, we prospectively enrolled 114 patients who underwent BCS using US-guided ICG-F marking and we compared these results with 300 patients who underwent BCS using US-guided skin marking from January 2012 to December 2016. Clinical features, identification rates, status of resection margins, and re-operation rates were analyzed. The ICG-F identification rate was 100% (114/114). The mean approach time for resection of the lesion ICG-F using group was about 13 min. The positive rate of frozen resection margins was 10.5% using ICG-F and 25.0% using sono-guided skin marking (p < 0.01). The rate of additional intraoperative resection was significantly lower in the ICG-F marking group compared to that in the sono-guided skin marking group (8.8% vs. 23.3%, p < 0.01). The rate of final positive resection margins was 3.5% in the ICG-F using group and 14.7% in the sono-guided skin marking group (p < 0.01). The rate of re-operation was 4.4% in the ICG-F using group and 4% in the sono-guided group (p = 0.79). At follow-up after the operation using ICG-F, no complications occurred. Using ICG-F during BCS could be a safe, sophisticated method for localization.

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“…In this study, both CNSL and MBL help to accomplish the complete resection of 172 lesions, indicating that the dye localization was a feasible and effective auxiliary technique in the resection of NPBL. Complete resection of NPBL while avoiding excessive resection of normal tissue is significant for cosmetic outcomes ( 32 ). Our results revealed that the TRV and CRR of the CNSL group were significantly lower compared to those of the MBL group.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study

et al. 2021

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Background: The resection of nonpalpable breast lesions (NPBLs) largely depends on the preoperative localization technology. Although several techniques have been used for the guidance of NPBL resection, more comfortable and effective methods are needed. This aim of this study was to evaluate the use and feasibility of carbon nanoparticle suspension (CNS) and methylene blue (MB)-guided resection of NPBL, to introduce alternative techniques.Methods: A total of 105 patients with 172 NPBLs detected by breast ultrasound were randomized to CNS localization (CNSL) group and MB localization (MBL) group. The injection times of the two groups were divided into 2, 4, 6, 12, 16, and 20 h before surgery. In this study, localization time, stained area, operation time, total resection volume (TRV), calculated resection ratio (CRR), and pathological diagnosis were assessed.Results: All of the 172 lesions were finally confirmed benign. Dye persisted in all cases in the CNSL group (109/109, 100%), while that persisted in only 53 cases in the MBL group (53/63, 84.1%) (P < 0.001). There was a significant correlation between dyeing time and dyeing area in the MBL group (r = −0.767, P < 0.001); however, there was no significant correlation in the CNSL group (r = −0.154, P = 0.110). The operation time was 11.05 ± 3.40 min in the CNSL group and 13.48 ± 6.22 min in the MBL group (P < 0.001). The TRV was 2.51 ± 2.42 cm3 in the CNSL group and 3.69 ± 3.24 cm3 in the MBL group (P = 0.016). For CRR, the CNSL group was lower than the MBL group (7.62 ± 0.49 vs. 21.93 ± 78.00, P = 0.018). There is no dye remained on the skin in the MBL group; however, dye persisted in 12 patients (19.4%) in the CNSL group (P = 0.001).Conclusion: Carbon nanoparticle suspension localization and MBL are technically applicable and clinically acceptable procedures for intraoperatively localizing NPBL. Moreover, given the advantages of CNSL compared to MBL, including the ability to perform this technique 5 days before operation and smaller resection volume, it seems to be a more attractive alternative to be used in intraoperative localization of NPBL.

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Indocyanine green fluorescence-guided lumpectomy of nonpalpable breast cancer versus wire-guided excision: A randomized clinical trial

Cited by 10 publications

References 9 publications

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

Surgical outcomes of localization using indocyanine green fluorescence in breast conserving surgery: a prospective study

Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study

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