Nerve autofluorescence to enhance nerve visualization during axillary lymph node dissection in three breast cancer patients: Case series

Abstract

Introduction and importance: Iatrogenic nerve injury is a possible complication of axillary lymph node dissection (ALND), which remains standard-of-care for some breast cancer patients. Recently, several studies have demonstrated that nerves auto-fluoresce in near-ultraviolet light (NUVL). We describe three women with BC in whom a recently-developed NUVL camera was used to facilitate visualization of and prevent iatrogenic injury to the intercostobrachial, long thoracic, and thoracodorsal nerves during ALND.

Case presentation: In all three women, ALND was deemed necessary per current guidelines for the treatment of locally-advanced breast cancer following neoadjuvant chemotherapy. The surgery was performed using standard-of-care surgical techniques, except that a Dendrite® Imaging System was employed to visualize the surgical field both in white light and NUVL. In all patients, all nerves fluoresced brightly throughout their course in the surgical field. Such visualization was crucial during resection of lymph nodes close to nerves. No peri-operative complications occurred and no evidence of neurological injury was evident at one-month follow-up.

Clinical discussion: The Dendrite® Imaging System employs a NUVL light source and filter system to detect fluorescent signals emitted by neural tissue. These signals then pass through a filter system within the camera head, are captured by a chip, and are transmitted to a dedicated software platform for real-time analysis, processing, and relay to a display screen, allowing the surgical team to observe neural structures with clarity.

Conclusion: In three breast cancer patients undergoing ALND, nerve autofluorescence under NUVL aided in visualizing and preventing injury to all nerves within the surgical field.

Keywords: Axillary lymph node dissection; Breast cancer; Dendrite® imaging system; Fluorescence imaging; Iatrogenic nerve injury; Nerve-sparing surgery.

Fig. 1

Dendite® imaging system.

Fig. 2

Intra-operative images of the axilla under A) standard operating room (white) light and B) near-ultraviolet light (NUVL) showing the intercostobrachial nerve (ICBN).

Fig. 3

Intra-operative images of the axilla under near-ultraviolet light showing the long thoracic nerve (LTN) and the thoraco-dorsal nerve (TDN).