Augmented-Reality ICG Fluorescence Second-Look for Residual Nodal Disease After Axillary Dissection in Breast Cancer (AR4SLN)
Prospective Evaluation of Augmented-Reality ICG Fluorescence Second-Look After Axillary Lymph Node Dissection in Breast Cancer
This prospective study will enroll up to 200 patients whose clinical team has already planned an axillary lymph node dissection for breast cancer. After the surgeon completes the planned dissection and declares that no further tissue was intended for removal, a wearable augmented-reality/virtual-reality (AR/VR) system will show indocyanine-green (ICG) near-infrared fluorescence during a brief second look at the exposed surgical field. The surgeon may remove an additional fluorescent focus only after inspection under normal light and only when removal is safe and clinically appropriate. Each additional specimen will be labeled separately and examined by pathology.
The study measures the proportion of patients with an additional tumor-positive lymph node found at second look, whether such nodes change the pathological nodal category, operating time, and adverse events. The first 50 consecutive participants will form a planned descriptive device-feasibility analysis; all 200 participants will contribute to the full-cohort clinical analysis. The study does not assume that finding an additional node improves recurrence or survival.
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
This is a prospective, single-center, single-arm study of 200 unique participants undergoing breast cancer surgery with axillary lymph node dissection independently indicated by the clinical team. Earlier observations from an internal, unregistered protocol are not included in this study population. The first 50 consecutive enrolled participants form a prespecified descriptive device-feasibility subset; they remain part of the full 200-patient cohort and are not a separate arm.
Before AR/VR imaging, the operating surgeon records the indication and extent of the planned axillary dissection and declares that the standard procedure and inspection are complete. A brief ICG near-infrared fluorescence second look is then performed with the wearable system within the already exposed operative field. Each additional fluorescent focus receives a unique identifier, anatomic location, image or video reference when available, and a record of whether it was visible or palpable under standard lighting. The surgeon reassesses the focus under standard lighting and removes it only when safe and clinically appropriate. Each removed focus is submitted separately for pathology. Negative scans, foci left in place, interrupted scans, device failures, and added operating time are recorded.
The primary outcome remains the patient-level rate of pathology-confirmed clinically significant events (CSE) already defined in this record: at least one additional fluorescent focus not planned for removal before the second look, removed after standard-light reassessment, and confirmed to be a lymph node containing isolated tumor cells, micrometastasis, or macrometastasis. These pathology categories are reported separately. For the clinical analysis, pathology determines the nodal category using the standard dissection specimens alone and again after adding separately labeled second-look specimens. The patient-level rate of change in pathological nodal category is reported separately from the CSE rate. Any documented change in the postoperative treatment recommendation is recorded separately from a pathology finding. Procedure- and device-related adverse events are followed for 30 days.
The first 50 participants support a descriptive report of device feasibility and workflow, including scan completion, localization of additional foci, pathology of removed foci, time, and failures. The full 200-patient cohort supports estimation of CSE yield and nodal-category change with confidence intervals. There is no conventional near-infrared camera comparator. This single-arm study does not establish an improvement in recurrence, survival, or other patient outcomes.
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Borislav Kondov, MD
- Telefoonnummer: +38972539003
- E-mail: borislav.kondov@medf.ukim.edu.mk
Studie Contact Back-up
- Naam: Magdalena Bogdanovska Todorovska, MD
- Telefoonnummer: +389709602221
- E-mail: magdalena.todorovska@medf.ukim.edu.mk
Studie Locaties
-
-
-
Skopje, Noord-Macedonië, 1000
- University Clinic for Thoracic and Vascular Surgery, Faculty of Medicine, UKIM
-
Contact:
- Borislav Kondov, MD
- Telefoonnummer: +38972539003
- E-mail: borislav.kondov@medf.ukim.edu.mk
-
-
Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Histologically proven breast cancer
- Age 18 years or older
- Undergoing radical surgery (mastectomy or quadrantectomy) with complete axillary lymph node dissection
- Provides written informed consent
Exclusion Criteria:
- Pregnancy
- Neoadjuvant chemotherapy
- Prior breast surgery
- Iodine or seafood allergy
- Indocyanine green (ICG) allergy
- Declines or is unable to provide informed consent
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Diagnostisch
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
|
Experimenteel: AR-ICG Second-Look
After the operating surgeon declares the axillary lymph node dissection complete, a brief augmented-reality ICG near-infrared fluorescence re-examination of the surgical field is performed. Additional fluorescent tissue is re-assessed under standard lighting and removed only if the surgeon judges removal safe and clinically appropriate; removed tissue undergoes separate histopathology. |
A wearable augmented-reality system displaying combined color and near-infrared fluorescence, with a handheld laser/white-light illuminator, used to re-examine the axillary field for residual ICG-fluorescent tissue after the surgeon declares the dissection complete. Indocyanine green is administered intraoperatively per protocol. |
Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Patient-level rate of clinically significant events (CSE)
Tijdsspanne: From intraoperative second-look review to final histopathology (up to approximately 2 weeks after surgery)
|
Proportion of patients with at least one clinically significant event (CSE). A CSE is defined as additional fluorescent tissue identified at the second-look review after the surgeon's declared completion of the axillary dissection, not previously planned for removal, removed after re-assessment under standard lighting, and confirmed on final histopathology to be a lymph node containing tumor (isolated tumor cells, micrometastasis, or macrometastasis). |
From intraoperative second-look review to final histopathology (up to approximately 2 weeks after surgery)
|
Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Distribution of additional fluorescent findings by tissue category
Tijdsspanne: Final histopathology (up to approximately 2 weeks after surgery)
|
Number of additional fluorescent findings classified on histopathology as tumor-positive lymph node, tumor-negative lymph node, or non-nodal tissue (e.g., fibro-adipose tissue or dye leakage). |
Final histopathology (up to approximately 2 weeks after surgery)
|
|
Anatomic location of additional fluorescent findings
Tijdsspanne: Intraoperative (day of surgery)
|
Anatomic location of each additional fluorescent finding, recorded as axillary level I, II, or III; interpectoral (Rotter); internal mammary; or other. |
Intraoperative (day of surgery)
|
|
Nodal stage migration
Tijdsspanne: Final histopathology (up to approximately 2 weeks after surgery)
|
Patient-level proportion whose pathological nodal category changes when separately labeled, pathology-confirmed second-look lymph nodes are added to the standard axillary dissection specimens. Determine pN first from the standard specimens alone and then from all specimens using the applicable breast cancer staging rules. Report the direction and category of each change; report isolated tumor cells separately and do not count them as positive nodes for pN thresholds. |
Final histopathology (up to approximately 2 weeks after surgery)
|
|
Added operative time for the second-look review
Tijdsspanne: Intraoperative (day of surgery)
|
Additional operative time required to perform the second-look review, in minutes. |
Intraoperative (day of surgery)
|
|
Procedure- or device-related adverse events
Tijdsspanne: Through 30 days after surgery
|
Number of participants with adverse events related to the study procedure or device. |
Through 30 days after surgery
|
|
AR/VR second-look technical completion rate
Tijdsspanne: Intraoperative (day of surgery)
|
Proportion of participants in whom the planned AR/VR ICG second-look scan is completed with live fluorescence displayed over the exposed axillary field. Record incomplete scans, device failures, and the reason for each. Summarize this outcome for all enrolled participants and separately for the prespecified first 50 participants. |
Intraoperative (day of surgery)
|
Medewerkers en onderzoekers
Sponsor
Sponsor
Medewerkers
Medewerkers
Publicaties en nuttige links
Algemene publicaties
- Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, Ollila DW, Hansen NM, Whitworth PW, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Morrow M. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017 Sep 12;318(10):918-926. doi: 10.1001/jama.2017.11470.
- Xiong X, Zheng LW, Ding Y, Chen YF, Cai YW, Wang LP, Huang L, Liu CC, Shao ZM, Yu KD. Breast cancer: pathogenesis and treatments. Signal Transduct Target Ther. 2025 Feb 19;10(1):49. doi: 10.1038/s41392-024-02108-4.
- Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, Cataliotti L, Westenberg AH, Klinkenbijl JH, Orzalesi L, Bouma WH, van der Mijle HC, Nieuwenhuijzen GA, Veltkamp SC, Slaets L, Duez NJ, de Graaf PW, van Dalen T, Marinelli A, Rijna H, Snoj M, Bundred NJ, Merkus JW, Belkacemi Y, Petignat P, Schinagl DA, Coens C, Messina CG, Bogaerts J, Rutgers EJ. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014 Nov;15(12):1303-10. doi: 10.1016/S1470-2045(14)70460-7. Epub 2014 Oct 15.
- de Boniface J, Filtenborg Tvedskov T, Ryden L, Szulkin R, Reimer T, Kuhn T, Kontos M, Gentilini OD, Olofsson Bagge R, Sund M, Lundstedt D, Appelgren M, Ahlgren J, Norenstedt S, Celebioglu F, Sackey H, Scheel Andersen I, Hoyer U, Nyman PF, Vikhe Patil E, Wieslander E, Dahl Nissen H, Alkner S, Andersson Y, Offersen BV, Bergkvist L, Frisell J, Christiansen P; SENOMAC Trialists' Group; SENOMAC Trialists' Group. Omitting Axillary Dissection in Breast Cancer with Sentinel-Node Metastases. N Engl J Med. 2024 Apr 4;390(13):1163-1175. doi: 10.1056/NEJMoa2313487.
Studie record data
Bestudeer belangrijke data
Studie start (Geschat)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
Andere studie-ID-nummers
- UKIM-AR-ICG-BREAST-2026
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Beschrijving IPD-plan
This is a single-center study of up to 200 participants. Individual participant data are not planned to be shared. De-identified data may be made available from the principal investigator on reasonable request, subject to institutional approval.
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .