Indocyanine green in breast cancer and reconstruction surgery

Abstract

Fluorescence-guided surgery using indocyanine green (ICG) is an emerging technique in breast cancer and reconstruction surgery, offering real-time insights into tissue perfusion and lymphatic mapping. This dissertation investigates its application in mastectomy with reconstruction and sentinel lymph node (SLN) biopsy.

Skin-sparing and nipple-sparing mastectomy followed by reconstruction aim to treat cancer while preserving cosmesis. However, mastectomy skin flap necrosis (MSFN), with rates up to 24%, remains a significant complication. Traditional intraoperative assessment of skin perfusion is subjective. Retrospective studies using ICG angiography demonstrated reduced flap necrosis rates and improved outcomes over time. A standardised protocol for ICG use was developed, and cost-effectiveness analysis confirmed its value in reducing ischaemic complications. A machine learning algorithm was also created to quantify ICG angiography and predict complications, addressing the lack of standardised interpretation methods.

SLN biopsy is essential for staging early breast cancer. Conventional tracers (blue dye and technetium-99m) are effective but have drawbacks including allergic reactions, radiation exposure, and infrastructure demands. ICG fluorescence offers a safer alternative. Two large prospective trials compared ICG to traditional methods, showing equivalency in SLN identification and metastatic node detection, with ICG proving less costly long-term. These findings support ICG as a viable alternative or supplement to existing techniques.

This research fills gaps in current literature and supports broader adoption of ICG fluorescence in breast cancer surgery. Continued validation may lead to improved surgical precision, reduced complications, and enhanced patient outcomes.