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Augmented-Reality ICG Fluorescence Second-Look for Residual Nodal Disease After Axillary Dissection in Breast Cancer (AR4SLN)

3 november 2026 bijgewerkt door: Borislav Kondov, Ss. Cyril and Methodius University of Skopje

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

Nog niet aan het werven

Conditie

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

Ingrijpend

Inschrijving (Geschat)

200

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Contact Back-up

Studie Locaties

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Vrouw

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

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Diagnostisch
  • Toewijzing: NVT
  • Interventioneel model: Opdracht voor een enkele groep
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / 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

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

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

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Medewerkers

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Geschat)

1 november 2026

Primaire voltooiing (Geschat)

1 oktober 2029

Studie voltooiing (Geschat)

1 november 2029

Studieregistratiedata

Eerst ingediend

28 juni 2026

Eerst ingediend dat voldeed aan de QC-criteria

6 juli 2026

Eerst geplaatst (Werkelijk)

10 juli 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

6 november 2026

Laatste update ingediend die voldeed aan QC-criteria

3 november 2026

Laatst geverifieerd

1 november 2026

Meer informatie

Termen gerelateerd aan deze studie

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?

NEE

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

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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 .