Abstract PD2-02: Indocyanine green fluorescence-guided video-assisted sentinel node biopsy: A prospective comparative study and cost-analysis
Authors: Sorrentino L , Mazzucchelli S , Truffi M , Pietropaolo G , Sartani A , Foschi D , Corsi F 
Published: February 2018

Background: Currently the standard techniques for sentinel node (SLN) detection in breast cancer are radioisotope (RI) and blue dye, but both methods present some drawbacks. Indocyanine green (ICG) fluorescence has been recently proposed as an alternative technique. However, the equipment to detect ICG fluorescence is not widely accessible, limiting the potential and the diffusion of this encouraging technique. The aim of this study was to assess the feasibility, accuracy and healthcare costs of a novel approach for SLN biopsy by a video-assisted ICG-guided technique.

Methods: A prospective study was performed enrolling 335 breast cancer patients: SLN was detected with RI in 194 cases, with ICG in 70 cases, and with ICG plus RI in 71 cases. ICG fluorescence was detected using a laparoscope with a near-infrared filter, and a video-assisted SLN biopsy was performed by approaching the camera in the axillary cavity. Detection rates were compared between ICG and RI. Healthcare costs were analyzed considering surgery and hospitalization times, stratified by type of surgery.

Results: In ICG + RI group, ICG detected 90.9% of metastatic SLNs, while RI and ICG + RI detected 100% of them. Detection rate was 100% with ICG + RI, 95.1% with RI and 92.7% with ICG. More SLNs per patient were identified with ICG and ICG + RI compared to RI (&lt;0.0001). Healthcare costs were equivalent among the 3 groups.

 ICG (n = 70)RI (n = 194)ICG + RI (n = 71)p value (ICG vs. RI)p value (RI vs ICG + RI)p value (ICG vs ICG + RI)Number of identified sentinel nodes8019582   Patients with 1 SLN61 (87.1%)193 (99.5%)61 (85.9%)&lt;0.001&lt;0.0011Patients with &gt;1 SLN9 (12.9%)1 (0.5%)10 (14.1%)   Missing of metastatic SLN      Yes1 (1.4%)0 (0.0%)0 (0.0%)0.2710.49No69 (98.6%)194 (100.0%)71 (100.0%)   SLN status      Negative/ITC63 (77.8%)149 (76.4%)71 (86.6%)0.340.170.23Micrometastasis5 (6.2%)22 (11.3%)5 (6.1%)   Macrometastasis13 (16.0%)24 (12.3%)6 (7.3%)   Mastectomy + SLN biopsy + Axillary dissection      Operative times (min)113.3 (±30.1)139 (±32.3)123.3 (±25.2)0.250.460.68Hospitalization (days)4.7 (±1.2)6.7 (±1.7)5.7 (±1.5)0.090.380.42Total cost per patient4,145.2€ (±787.9€)5,723€ (±1,099.9€)5,005.2€ (±966.3€)0.040.330.29Mastectomy + SLN biopsy      Operative times (min)119.4 (±33.9)89.3 (±32.1)103.8 (±18.5)0.050.250.27Hospitalization (days)4.6 (±1.2)4.6 (±0.7)3.9 (±1.4)10.120.3Total cost per patient4,123.3€ (±794.9€)4,053.6€ (±494.6€)3,731.4€ (±896.5€)0.790.280.37Lumpectomy + SLN biopsy + Axillary dissection      Operative times (min)96.9 (±28.9)111.5 (±31.8)92 (±10.4)0.260.190.73Hospitalization (days)4 (±1.5)4.7 (±1.6)4 (±2)0.280.391Total cost per patient3,589.9€ (±971.1€)4,268€ (±1,037.2€)3,714.6€ (±1,269.9€)0.110.300.85Lumpectomy + SLN biopsy      Operative times (min)70.9 (±32.3)67.4 (±17.9)66.8 (±20.4)0.340.840.43Hospitalization (days)2.2 (±0.9)2.2 (±0.6)2.1 (±0.4)10.260.46Total cost per patient2,271.9€ (±611.4€)2,383.1€ (±399.4€)2,338.6€ (±289.1€)0.140.450.47

Conclusions: Video-assisted ICG fluorescence-guided SLN biopsy is a feasible technique with comparable efficacy compared to RI. Combining ICG and RI resulted in a significantly higher detection rate and identification of more SLNs per patients, providing a more accurate staging of the axilla.

Citation Format: Sorrentino L, Mazzucchelli S, Truffi M, Pietropaolo G, Sartani A, Foschi D, Corsi F. Indocyanine green fluorescence-guided video-assisted sentinel node biopsy: A prospective comparative study and cost-analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-02.