TY - JOUR
T1 - Indocyanine Green Angiography – Current Status on Quantification of Perfusion
T2 - a narrative review
AU - Andersen, Frederik Thørholm
AU - Hasenkam, J. Michael
AU - Damsgaard, Tine Engberg
PY - 2024/12
Y1 - 2024/12
N2 - Background and Objective: Flap ischemia poses a formidable challenge in breast reconstruction. Indocyanine green fluorescence angiography (ICG-FA) has shown promising results, yet a consensus on the quantification of perfusion during breast reconstruction remains elusive. This narrative review provides an overview and assesses the feasibility of current ICG-FA methodologies for quantifying tissue perfusion in breast reconstruction. Methods: The technical background for quantitative ICG-FA is investigated, conducting a semi-structured search in PubMed and Embase. The data analysis focuses on unfolding the technical background, operative setup, critical factors impacting its reproducibility, individual biases, and reliability of different methodologies. Furthermore, we propose a strategic framework for identifying the optimal methodology to quantify perfusion in breast reconstruction. Key Content and Findings: Imaging devices developed by two companies Novadac and then Stryker (SPY Elite, SPY-PHI) have predominantly been employed, accompanied by an exploration of commercial and custom software. Most studies have explored intensity-dependent or relative parameters based on intensity. However, investigations into these parameters reveal susceptibility to bias. In contrast, combined and time-related parameters demonstrate resilience to bias, but await further validation. Intra-operative body surface warming, micro-dosing regimens, and tailoring analysis based on flap type may establish methodological refinements. Conclusions: ICG-FA appears promising in accessing perfusion in breast reconstruction procedures. However, concerns persist regarding the reliability of intensity-dependent parameters. Combined and time-related parameters show potential, pending further validation. Strategies, including intra-operative warming and micro-dosing regimens, may refine the method. Ongoing research is needed to establish the optimal methodology for improved surgical decision-making.
AB - Background and Objective: Flap ischemia poses a formidable challenge in breast reconstruction. Indocyanine green fluorescence angiography (ICG-FA) has shown promising results, yet a consensus on the quantification of perfusion during breast reconstruction remains elusive. This narrative review provides an overview and assesses the feasibility of current ICG-FA methodologies for quantifying tissue perfusion in breast reconstruction. Methods: The technical background for quantitative ICG-FA is investigated, conducting a semi-structured search in PubMed and Embase. The data analysis focuses on unfolding the technical background, operative setup, critical factors impacting its reproducibility, individual biases, and reliability of different methodologies. Furthermore, we propose a strategic framework for identifying the optimal methodology to quantify perfusion in breast reconstruction. Key Content and Findings: Imaging devices developed by two companies Novadac and then Stryker (SPY Elite, SPY-PHI) have predominantly been employed, accompanied by an exploration of commercial and custom software. Most studies have explored intensity-dependent or relative parameters based on intensity. However, investigations into these parameters reveal susceptibility to bias. In contrast, combined and time-related parameters demonstrate resilience to bias, but await further validation. Intra-operative body surface warming, micro-dosing regimens, and tailoring analysis based on flap type may establish methodological refinements. Conclusions: ICG-FA appears promising in accessing perfusion in breast reconstruction procedures. However, concerns persist regarding the reliability of intensity-dependent parameters. Combined and time-related parameters show potential, pending further validation. Strategies, including intra-operative warming and micro-dosing regimens, may refine the method. Ongoing research is needed to establish the optimal methodology for improved surgical decision-making.
KW - breast reconstruction
KW - indocyanine green (ICG)
KW - Optical imaging
KW - perfusion
KW - quantification
UR - http://www.scopus.com/inward/record.url?scp=85212102295&partnerID=8YFLogxK
U2 - 10.21037/abs-24-15
DO - 10.21037/abs-24-15
M3 - Review
AN - SCOPUS:85212102295
VL - 8
JO - Annals Of Breast Surgery
JF - Annals Of Breast Surgery
M1 - 33
ER -