Imperial College London
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Mr Daniel Richard Leff

Faculty of Medicine, Department of Surgery & Cancer

Reader in Breast Surgery
 
 
 
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Contact

 

d.leff Website

 
 
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Location

 

016Paterson WingSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kedrzycki:2021:10.1245/s10434-021-10503-2,
author = {Kedrzycki, MS and Leiloglou, M and Chalau, V and Chiarini, N and Thiruchelvam, PTR and Hadjiminas, DJ and Hogben, KR and Rashid, F and Ramakrishnan, R and Darzi, AW and Elson, DS and Leff, DR},
doi = {10.1245/s10434-021-10503-2},
journal = {Annals of Surgical Oncology},
pages = {5617--5625},
title = {The impact of temporal variation in indocyanine green administration on tumor identification during fluorescence guided breast surgery.},
url = {http://dx.doi.org/10.1245/s10434-021-10503-2},
volume = {28},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: On average, 21% of women in the USA treated with Breast Conserving Surgery (BCS) undergo a second operation because of close positive margins. Tumor identification with fluorescence imaging could improve positive margin rates through demarcating location, size, and invasiveness of tumors. We investigated the technique's diagnostic accuracy in detecting tumors during BCS using intravenous indocyanine green (ICG) and a custom-built fluorescence camera system. METHODS: In this single-center prospective clinical study, 40 recruited BCS patients were sub-categorized into two cohorts. In the first 'enhanced permeability and retention' (EPR) cohort, 0.25 mg/kg ICG was injected ~ 25 min prior to tumor excision, and in the second 'angiography' cohort, ~ 5 min prior to tumor excision. Subsequently, an in-house imaging system was used to image the tumor in situ prior to resection, ex vivo following resection, the resection bed, and during grossing in the histopathology laboratory to compare the technique's diagnostic accuracy between the cohorts. RESULTS: The two cohorts were matched in patient and tumor characteristics. The majority of patients had invasive ductal carcinoma with concomitant ductal carcinoma in situ. Tumor-to-background ratio (TBR) in the angiography cohort was superior to the EPR cohort (TBR = 3.18 ± 1.74 vs 2.10 ± 0.92 respectively, p = 0.023). Tumor detection reached sensitivity and specificity scores of 0.82 and 0.93 for the angiography cohort and 0.66 and 0.90 for the EPR cohort, respectively (p = 0.1051 and p = 0.9099). DISCUSSION: ICG administration timing during the angiography phase compared with the EPR phase improved TBR and diagnostic accuracy. Future work will focus on image pattern analysis and adaptation of the camera system to targeting fluorophores specific to breast cancer.
AU  - Kedrzycki,MS
AU  - Leiloglou,M
AU  - Chalau,V
AU  - Chiarini,N
AU  - Thiruchelvam,PTR
AU  - Hadjiminas,DJ
AU  - Hogben,KR
AU  - Rashid,F
AU  - Ramakrishnan,R
AU  - Darzi,AW
AU  - Elson,DS
AU  - Leff,DR
DO  - 10.1245/s10434-021-10503-2
EP  - 5625
PY  - 2021///
SN  - 1068-9265
SP  - 5617
TI  - The impact of temporal variation in indocyanine green administration on tumor identification during fluorescence guided breast surgery.
T2  - Annals of Surgical Oncology
UR  - http://dx.doi.org/10.1245/s10434-021-10503-2
UR  - https://www.ncbi.nlm.nih.gov/pubmed/34347221
UR  - https://link.springer.com/article/10.1245%2Fs10434-021-10503-2
UR  - http://hdl.handle.net/10044/1/90984
VL  - 28
ER  -
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