A novel approach for sentinel lymph node identification using fluorescence imaging and image overlay navigation surgery in patients with breast cancer

Abstract

624 Background: We reported a novel technique of sentinel lymph node (SLN) identification using fluorescence imaging of indocyanine green injection. Furthermore, to obtain safe and accurate identification of SLN during surgery, we introduce the image overlay navigation surgery and evaluate its efficacy. Methods: This study enrolled 30 patients with a tumor less than 3 cm in diameter. Initially we obtained three-dimensional (3-D) imaging from MD-CT by volume rendering of Osirix (Macintosh, Apple Inc.). It was projected on the patient’ operative field with the clear visualization of LN through the micro projector (Mpro 110, Sumitomo 3M). And then the dye of indocyanine green was injected subdermally in the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were visible by fluorescence imagings (Photodynamic eye: PDE, Hamamatsu Photonics Co.) immediately. Lymphatic flow was reached after LN revealed on 3-D imaging. After incising the axillary skin on the point of LN mapping, SLN was then dissected under the guidance of fluorescence and 3-D imaging with adequate adjustment of sensitivity. Results: Lymphatic channels and SLN were successfully identified by PDE in all patients. And the sites of skin incision were also identical with the LN being demonstrated by 3-D imaging in all patients. The mean number of SLN was 2.8. The adjustment of sensitivity of PDE provide with the reduction of operation time. The image overlay navigation surgery was visually easy to identify the location of SLN from the axillary skin. There were no intra- or postoperative complications associated with SLN identification. Conclusions: This combined navigations of fluorescence and 3-D imagings revealed more easy and effective to detect SLN intraoperatively than fluorescence imaging alone. The operator's demand was satisfied with the introduction of image overlay navigation surgery consisted of augmented reality and mixed reality, and it may be practical in the various surgical fields. No significant financial relationships to disclose.