Upgraded portable Indocyanine Green (ICG) detection system - towards Image Guided Cancer Surgery

Objectives: Our previous optical imaging work allowed us to build a portable indocyanine green (ICG) detection system to be used with 99mTc nanocolloid ICG (99mTc-N-ICG) (1), during surgical procedures such as in sentinel node mapping procedures in breast and melanoma patients. The aim of the current study was to describe an upgraded ICG detection system (ICGDS)(Figure 1,2) and results obtained during axillary sentinel node biopsy (SLNB) procedures for breast cancer staging.

Methods: The new ICGDS has the specifications described in Table 1 and it was used in BCSN procedures. We performed 10 SLNB procedures using 99mTc-N-ICG. Injection of the tracer was performed perioareolar subcutaneously in the same quadrant of the tumor. Lymphoscintigrapy and SPECT-CT were acquired prior surgery. Intraoperative SN localization was performed using a gamma probe and ICGDS. Room lights were dimmed or turned off during ICGDS use. Intraoperative localization of SN was made using acoustic cues from the probe that guided surgeon to the region where the node was located and later ICGD allowed to visually identify them (Figure3).

Results: The new ICGDS allowed us to identify 18 SLNs that were radioactive and fluorescent and provided enhanced confidence to surgeon to precisely remove the relevant nodes, and spare non hybrid nodes, particularly when nodes were clustered. We did not any radioactive only or fluorescent only nodes. All fluorescent nodes were radioactive.

Conclusion: The new portable ICG detection system was able to detect 99mTc-N-ICG. These procedures were safe and carried out without complications. Advances in instrumentation and novel specific targeting fluorescent or hybrid tracers may improve patient outcomes. 1. J Nucl Med May 2014 vol. 55 no. supplement 1 1447 Research Support: ANII, CSIC I+D, EI, SCIENCE AND INNOVATION CALLS AT THE BRITISH EMBASSY IN MONTEVIDEO $$graphic_9FE4731B-22CD-43A7-91F7-59A0FE05CC4C$$ $$graphic_E26305D6-D45C-490C-90EC-BCE0069AA001$$ $$graphic_07689BCF-763C-4996-9D94-C29BE6FD7F3C$$