IC-Flow™ Indications | Oncology


Flourescent Dye-Guided SLN Detection

Flourescent dye-guided SLN detection
SLN detection with IC-Flow™. Universitätsklinikum Tübingen

The primary application of the IC-Flow in oncology is  the detection of Sentinel Lymph nodes (SLNs), especially in breast cancer. Malignant tumors (cancer) can spread their cells via blood or lymph vessels, which leads to growth of metastases. In case of lymphatic spread, tumor cells accumulate in lymph nodes. The Sentinel Lymph Node (SLN) is defined as the first lymph node (or group of nodes) that receives drainage from a tumor. Examination of the SLN can reveal whether a tumor has already spread and is very important for determining the further treatment of the patient.

Benefits

  • Non-invasive, real-time visualization 1,2,10
  • Radioisotopes not required 2-4
  • Safe imaging technique 1-13
  • Visualization of lymph system within a couple of minutes after injection 1-6, 8-13
ICFlow-FlourDyeGuidedSLNBreastDiagram

 

Detection Procedure with IC-Flow Imaging System

SLN1-Injection
1. Injection
The fluorescent dye is injected into the periareolar region of the breast after initiation of anesthesia. Visualization of the fluorescence can
be supported by massaging the breast. 1-6, 8-13 In cases of subdermal injection, visualization of the SLNs takes longer.
SLN2-Mapping
2. Mapping lymphatic vessels
By using the IC-Flow camera the fluorescent lymph flow can be visualized. Then the subcutaneous lymph vessels can easily be mapped which will help to avoid cutting a lymph vessel during a surgery.2 Following intradermal injection, SLNs can be observed after approximately 15 minutes. 1-6, 8-13
SLN3-Identification
3. Identification of SLN
SLNs are localized percutaneously and usually can’t be visualized without incising the skin as they are located deeper than 1.5 cm. Often they are below the area where the lymph vessel fluorescence disappears. If the patient has little subcutaneous fat they can sometimes be localized without incision.9 The SLNs are detected as bright, fluorescent spots.
SLN4-Extraction
Fig. 1-8 SLN detection procedure with IC-Flow.AGAPLESION Markus Krankenhaus, Frankfurt, Germany
4. SLN extraction
All fluorescent SLNs should be removed. By checking the existence of fluorescence in the extracted lymph nodes surgeons confirm that those are the SLNs. At the end of the procedure it is important to examine the axilla in order to make sure that no fluorescent SLNs are left. Afterwards the status of the SLNs will be determined by pathological inspection. 1-6, 8-13

 

Published Studies On Flourescent Dye-Guided SLN Detection

No. of patients Blue dye Technetium-99m Fluorescent dye
SLN identification by visual observation gamma probe fluorescenceguided camera
Tagay (2008) 11 25 92% 100%
Hojo (2010) 4 141 92,9% (105/113) 100% (28/28) 99,3% (140/141)
Abe (2011) 1 128 66% 100%
Polom (2012) 9 49 100% 98%
Wishart (2012) 13 100 95% 77,6% 100%
Ballardni (2013) 3 134 93,9% 99,6%

 

Literature

  1. Abe H. et al. Indocyanine Green Fluorescence Imaging System for Sentinel Lymph Node Biopsies in Early Breast Cancer Patients. Surg. Today (2011);41(2):p.197–202.
  2. Aoyama K. et al. Sentinel Lymph Node Biopsy for Breast Cancer Patients Using Fluorescence Navigation with Indocyanine Green. World J Surg Oncol (2011);9:p.157.
  3. Ballardini B. et al. The indocyanine green method is equivalent to the 99mTc-labeled radiotracer method for identifying the sentinel node in breast cancer: A concordance and validation study. Eur J Surg Oncol (2013);39(12):p.1332-6.
  4. Hojo T. et al. Evaluation of Sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer. Breast (2010);19(3):p. 210-3.
  5. Hirche C. et al. High Rate of Solitary Sentinel Node Metastases Identification by Fluorescence-Guided Lymphatic Imaging in Breast Cancer. J. Surg. Oncol. (2011);105(2):p.162-6.
  6. Kitai T. et al. Fluorescence Navigation with Indocyanine Green for Detecting Sentinel Lymph Nodes in Breast Cancer. Breast Cancer (2005);12(3):p. 211-5.
  7. Mihara M. et al. Scarless lymphatic venous anastomosis for latent and early-stage lymphoedema using indocyanine green lymphography and non-invasive instruments for visualising subcutaneous vein. J Plas Recon (2012);65(11):p. 1551-8.
  1. Murawa D. et al. Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence. Br J Surg (2009);96(11):p. 1289-94.
  2. Polom K. et al. Breast cancer sentinel lymph node mapping using near infrared guided indocyanine green and indocyanine green-human serum albumin in comparison with gamma emitting radioactive colloid tracer. Eur J Surg Oncol (2012);38:2,p. 137-142.
  3. Sugie T. et al. A Novel Method for Sentinel Lymph Node Bopsy by Indocyanine Green Fluorescence Technique in Breast Cancer. Cancers (2010);2(2):p. 713-20.
  4. Tagaya N. et al. Intraoperative identification of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer. Am J Surg (2008);195(6):p. 850-3.
  5. Veronesi U. et al. A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer. N Engl J Med (2003);349(6):p. 546-53.
  6. Wishart G. et al. A feasibility study (ICG-10) of indocyanine green (ICG) fluorescence mapping for sentinel lymph node detection in early breast cancer. Eur J Surg Oncol (2012);38(8):p. 651-6.