Abstract 104P
Background
Breast cancer treatment-related lymphedema (BCRL) is a significant morbidity after axillary lymph node dissection (ALND), and fluorescence imaging has been considered the most sensitive tool to detect lymphatic vessel abnormalities in lymphedema. However, it requires a high-cost near-infrared (NIR) camera. Therefore, a low-cost NIR camera should be developed to facilitate BCRL diagnosis. This study analyzed the image quality of lymph vessel patterns between the standard and low-cost cameras.
Methods
This was a prospective cross-sectional study that evaluated the lymph vessel patterns (linear, splash, stardust, and diffuse) of breast cancer after ALND between February 2022 and June 2023. Image quality analyses, i.e., intensity, signal-to-noise ratio (SNR), and contras-to-noise ratio (CNR), were taken between low-cost and standard NIR cameras. Bland-Altman analyses were used with a priori acceptable clinically important limits of agreement based on our pilot study.
Results
A total of 120 images from 73 patients were analyzed. We found no bias of all patterns except for linear and splash intensity, stardust SNR, and linear and splash CNR with mean differences (95% CI) of -14.6 (-22.6 – -6.6) AI; -14.1 (-27.6 – -0.6) AI; 0.6 (0.1 – 1.2); 0.4 (0.02 – 0.91); 0.5 (0,1 – 0,9) respectively. We also analyzed the trends of the plots. The low-cost camera captured higher intensity on higher mean values on splash patterns. On linear patterns, the low-cost camera tended to capture lower SNR. However, there were no other systematic biases in other plots. For linear, splash, stardust, and diffuse pattern respectively, intensity analyses showed limit of agreement of -56.7-27.5 AI; -85.1-56.8 AI; -73.1-82.9 AI; and -52.7-53.1 AI, the SNR analyses were -1.3-1.3; -3.2-2.8; -2.4-3.7; and -4.6-4.8, and the CNR analyses exhibited -1.7-2.6; -1.8-2.8; -2.2-2.6; -2.0-1.8. Intensity, SNR, and CNR analyses fell within the predefined limit among all lymphatic patterns.
Conclusions
The low-cost NIR camera indicated a good agreement of fluorescence lymph vessel imaging with the standard camera among post-ALND patients. Further study is needed to assess its diagnostic utility in BCRL patients.
Legal entity responsible for the study
The authors.
Funding
Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia.
Disclosure
All authors have declared no conflicts of interest.