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NCT Number: NCT06085274

Sentinel lympH Node Biopsy With Indocyanine Green in Breast Cancer After NEoadjuvant Chemotherapy (SHINE)

This is a prospective, open-label, within-patient clinical trial to determine the accuracy of Indocyanine green (ICG) guided sentinel lymph node biopsy (SLNB) compared to the standard dual-tracer SLNB in breast cancer patients who have had chemotherapy as a first treatment using a non-inferiority design.

Patients with operable breast cancer treated with chemotherapy and eligible for SLNB will be included in the study. During surgery, ICG will be injected and used to identify fluorescent sentinel nodes using a hand-held imaging camera; radiotracer and blue dye will also be used as per standard protocols. Intraoperative and clinicopathologic outcomes such as complications, characteristics of nodes, false negative rates and feasibility will be assessed. Patients will be asked to complete standardized patient reported outcome questionnaires (Breast-Q, FACT-B+4, VAS) to define the patient experience with this novel technique.

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Key information

Conditions

Breast Cancer Breast Diseases Breast Neoplasms Neoplasms Neoplasms by Site Skin Diseases Skin and Connective Tissue Diseases

Age range

18 year–80 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adults ≥ 18 and ≤ 80
  • Stage I-III core biopsy confirmed invasive breast cancer, who have undergone neoadjuvant chemotherapy and are planned to undergo SLNB with dual tracer (blue dye+Tc-99m)
  • Eastern Cooperative Oncology Group (ECOG) < 2
  • No ICG/iodine allergy
  • Capable of providing informed consent
  • English literacy

Exclusion criteria

  • Significant medical comorbidities (ASA 4)
  • Breast cancer stage T4/inflammatory or N2 disease at presentation (SLNB is contra-indicated in this setting)
  • Clinical node positive after neoadjuvant therapy (SLNB is contra-indicated in this setting)
  • Previous axillary surgery or breast/axillary radiotherapy to ipsilateral breast
  • Active pregnancy or breastfeeding

Treatment and study plan

ICG guided sentinel lymph node biopsy

Procedure

During sentinel lymph node biopsy the surgeon will inject a volume of 0.1ml divided into 2 doses (0.05ml each) of 2.5mg/mL ICG into the periareolar dermis of the involved breast. Technetium and blue dye will also be administered as per standard of care. The surgeon will assess the axilla with the the SPY-PHI near infrared imaging system to identify and remove ICG-fluorescent nodes; Any other sentinel lymph nodes identified will also be removed as per standard of care. If there is no progression of ICG towards the axilla, or if no ICG sentinel lymph node can be identified, an alternate injection technique involving peritumoural injection at 2-3 locations near the cancer site in the subcutaneous or dermal space of 0.05ml will be utilized.

Primary outcomes

  1. Non-inferiority of ICG SLNB compared to dual-tracer SLNB in post-neoadjuvant chemotherapy treated breast cancer patients.

    Time frame: From Technetium-99 (Tc-99m) injection to the completion of surgery

    Proportion of lymph nodes identified with ICG compared to the proportion of lymph nodes identified with dual tracer (blue dye/Tc-99m gamma probe)

Secondary outcomes

  1. Complications/safety

    Time frame: From time of Technetium-99 (Tc-99m) injection to 30 days after surgery

    Surgical intra-operative and post-operative complications will be collected to determine safety outcomes. All intra-operative complications will be graded using the ClassIntra classification. All post-operative complications (up to 30 days post-surgical treatment) will be graded using the Clavien-Dindo classification. Treatment-related adverse events will be assessed by CTCAE v5.0.

  2. Patient reported outcome measures - Visual Analog Scale

    Time frame: From baseline/enrolment to 12 months from surgery

    Patients' self-report the intensity of their pain. Scale 0-10, where 10 indicated worst pain possible.

  3. Patient reported outcome measures - FACT-B+4

    Time frame: From baseline/enrolment to 12 months from surgery

    Breast cancer patients' self-report on various dimensions of their Quality of Life: Measures physical well-being (score range 0-28; higher score = worse outcome), social/family well-being (score range 0-28; higher score = better outcome), emotional well-being (score range 0-24; higher score = worse outcome), functional well-being (score range 0-28; higher score = better outcome), breast cancer subscale (score range 0-28; higher score = worse outcome), lymphedema subscale (score range 0-20; higher score = worse outcome).

  4. Patient reported outcome measures - Breast-Q

    Time frame: From baseline/enrolment to 12 months from surgery

    Breast cancer patients' self-report their perceptions of domains of Quality of Life. Scale 0-100; 100 indicates better satisfaction.

Other outcomes

  1. Budget impact analysis

    Time frame: 1 year

    We will quantify all direct costs associated with implementation of ICG guided SLNB in breast cancer and annual operational costs; these will enable a comparison to cost of the current standard SLNB with Tc-99m and blue dye, including nuclear medicine infrastructure, technicians, and additional health care visits.

Study contacts

Contact information is provided by the study sponsor or research team.

Karineh Kazazian, MD PhD FRCSC

CONTACT

[email protected]

4163403444

Tulin Cil, MD MSc FRCSC

CONTACT

[email protected]

416-946-4501 ext. 3984

Sponsors and collaborators

Lead sponsor

University Health Network, Toronto

Other

Registry information

Official study title

Sentinel lympH Node Biopsy With Indocyanine Green in Breast Cancer After NEoadjuvant Chemotherapy (SHINE): A Prospective Clinical Trial

Acronym: SHINE

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Oct 16, 2023
Registry last updated
Dec 19, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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