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Abstract
Assessment of the sentinel lymph node (SLN) in patients with early stage breast cancer is vital in selecting the appropriate surgical approach. However, the existing methods, including methylene blue and nuclides, possess low efficiency and effectiveness in mapping SLNs, and to a certain extent exert side effects during application. Indocyanine green (ICG), as a fluorescent dye, has been proved reliable usage in SLN detection by several other groups. In this paper, we introduce a novel surgical navigation system to detect SLN with ICG. This system contains two charge-coupled devices (CCD) to simultaneously capture real-time color and fluorescent video images through two different bands. During surgery, surgeons only need to follow the fluorescence display. In addition, the system saves data automatically during surgery enabling surgeons to find the registration point easily according to image recognition algorithms. To test our system, 5 mice and 10 rabbits were used for the preclinical setting and 22 breast cancer patients were utilized for the clinical evaluation in our experiments. The detection rate was 100% and an average of 2.7 SLNs was found in 22 patients. Our results show that the usage of our surgical navigation system with ICG to detect SLNs in breast cancer patients is technically feasible.
Highlights
A sentinel lymph node (SLN) is the first lymph node (LN) or a group of LNs draining from the breast [1]
Three detection reagents are used for detecting SLNs in clinical settings: (1) blue dye, which is widely used due to its inexpensiveness, but has limited ability to visualize afferent lymphatic vessels and SLNs [6]; (2) radioactive colloids, which require a physician specializing in nuclear medicine, to use a handheld gamma counter, making SLN localization difficult; and (3) indocyanine green (ICG), which gives a fluorescent signal has been used by several other groups for locating SLNs in breast cancer to give a reliable higher signal-to-background ratio (SBR) [7,8,9,10,11,12,13,14,15,16,17,18,19,20], and in addition cheap and of low toxicity [7,21,22]
The distance between the light emitting diode (LED) light source and surgical area was around 10-20cm; if the distance was beyond 20cm, the fluorescent image became indistinguishable
Summary
A sentinel lymph node (SLN) is the first lymph node (LN) or a group of LNs draining from the breast [1]. Three detection reagents are used for detecting SLNs in clinical settings: (1) blue dye, which is widely used due to its inexpensiveness, but has limited ability to visualize afferent lymphatic vessels and SLNs [6]; (2) radioactive colloids, which require a physician specializing in nuclear medicine, to use a handheld gamma counter, making SLN localization difficult; and (3) indocyanine green (ICG), which gives a fluorescent signal has been used by several other groups for locating SLNs in breast cancer to give a reliable higher signal-to-background ratio (SBR) [7,8,9,10,11,12,13,14,15,16,17,18,19,20], and in addition cheap and of low toxicity [7,21,22] The fluorescent dyes, such as ICG, with a high SBR and detection depth in real-time observation enable superior SLN detection compared to the other two reagents.
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