Sentinel Lymph Node Biopsy in Vulvar Cancer using Combined Radioactive and Fluorescence Guidance
Identifieur interne : 001849 ( Main/Exploration ); précédent : 001848; suivant : 001850Sentinel Lymph Node Biopsy in Vulvar Cancer using Combined Radioactive and Fluorescence Guidance
Auteurs : Floris P. R. Verbeek [Pays-Bas] ; Quirijn R. J. G. Tummers [Pays-Bas] ; Daphne D. D. Rietbergen [Pays-Bas] ; Alexander A. W. Peters [Pays-Bas] ; Boudewijn E. Schaafsma [Pays-Bas] ; Cornelis J. H. Van De Velde [Pays-Bas] ; John V. Frangioni [États-Unis] ; Fijs W. B. Van Leeuwen [Pays-Bas] ; Katja N. Gaarenstroom [Pays-Bas] ; Alexander L. Vahrmeijer [Pays-Bas]Source :
- International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [ 1048-891X ] ; 2015.
Abstract
Near-infrared (NIR) fluorescence imaging using Indocyanine Green (ICG) has recently been introduced to improve the SLN procedure. Several optical tracers have been successfully tested. However, the optimal tracer formulation is still unknown. This study evaluates the performance of ICG–99mTc-nanocolloid in relation to two most commonly used ICG-based formulas during SLN biopsy of vulvar cancer.
12 women planned to undergo SLN biopsy for stage I vulvar cancer were prospectively included. SLN mapping was performed using the dual-modality radioactive and NIR fluorescence tracer ICG-99mTc-Nanocolloid. All patients underwent combined SLN localization using NIR fluorescence, and the (current) gold standard using blue dye and radioactive guidance.
In all 12 patients at least one SLN was detected during surgery. A total of 21 lymph nodes (median 2, range 1 – 3) were resected. Median time between skin incision and first SLN detection was 8 (range 1 – 22) minutes. All resected SLNs were both radioactive and fluorescent, though only 13 of 21 SLN (62%) stained blue. Median brightness of exposed SLNs, expressed as SBR, was 5.4 (range 1.8 – 11.8). Lymph node metastases were found in 3 patients.
NIR fluorescence guided SLN mapping is feasible and outperforms blue dye staining. Premixing ICG with 99mTc-nanocolloid provides real-time intra-operative imaging of the SN and appears the optimal tracer combination in terms of intraoperative detection rate of the SN (100%). Moreover, ICG-99mTc-Nanocolloid allows administration of a 5-times lower injected dose of ICG (compared to ICG and ICG:HSA) and can be injected the up to 20h before surgery.
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DOI: 10.1097/IGC.0000000000000419
PubMed: 25768079
PubMed Central: 4478233
Affiliations:
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R." last="Verbeek">Floris P. R. Verbeek</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Tummers, Quirijn R J G" sort="Tummers, Quirijn R J G" uniqKey="Tummers Q" first="Quirijn R. J. G." last="Tummers">Quirijn R. J. G. Tummers</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Rietbergen, Daphne D D" sort="Rietbergen, Daphne D D" uniqKey="Rietbergen D" first="Daphne D. D." last="Rietbergen">Daphne D. D. Rietbergen</name><affiliation wicri:level="3"><nlm:aff id="A2">Department of Radiology, Nuclear Medicine section and Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiology, Nuclear Medicine section and Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Peters, Alexander A W" sort="Peters, Alexander A W" uniqKey="Peters A" first="Alexander A. W." last="Peters">Alexander A. W. Peters</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Schaafsma, Boudewijn E" sort="Schaafsma, Boudewijn E" uniqKey="Schaafsma B" first="Boudewijn E." last="Schaafsma">Boudewijn E. Schaafsma</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Van De Velde, Cornelis J H" sort="Van De Velde, Cornelis J H" uniqKey="Van De Velde C" first="Cornelis J. H." last="Van De Velde">Cornelis J. H. Van De Velde</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Frangioni, John V" sort="Frangioni, John V" uniqKey="Frangioni J" first="John V." last="Frangioni">John V. Frangioni</name><affiliation wicri:level="2"><nlm:aff id="A4">Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Massachusetts</region></placeName><wicri:cityArea>Department of Radiology, Beth Israel Deaconess Medical Center, Boston</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="A5">Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Massachusetts</region></placeName><wicri:cityArea>Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston</wicri:cityArea></affiliation></author><author><name sortKey="Van Leeuwen, Fijs W B" sort="Van Leeuwen, Fijs W B" uniqKey="Van Leeuwen F" first="Fijs W. B." last="Van Leeuwen">Fijs W. B. Van Leeuwen</name><affiliation wicri:level="3"><nlm:aff id="A2">Department of Radiology, Nuclear Medicine section and Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Radiology, Nuclear Medicine section and Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Gaarenstroom, Katja N" sort="Gaarenstroom, Katja N" uniqKey="Gaarenstroom K" first="Katja N." last="Gaarenstroom">Katja N. Gaarenstroom</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Vahrmeijer, Alexander L" sort="Vahrmeijer, Alexander L" uniqKey="Vahrmeijer A" first="Alexander L." last="Vahrmeijer">Alexander L. Vahrmeijer</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgery, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author></analytic><series><title level="j">International journal of gynecological cancer : official journal of the International Gynecological Cancer Society</title><idno type="ISSN">1048-891X</idno><idno type="eISSN">1525-1438</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">Near-infrared (NIR) fluorescence imaging using Indocyanine Green (ICG) has recently been introduced to improve the SLN procedure. Several optical tracers have been successfully tested. However, the optimal tracer formulation is still unknown. This study evaluates the performance of ICG–<sup>99m</sup>Tc-nanocolloid in relation to two most commonly used ICG-based formulas during SLN biopsy of vulvar cancer.</p></sec><sec id="S2"><title>Methods/materials</title><p id="P2">12 women planned to undergo SLN biopsy for stage I vulvar cancer were prospectively included. SLN mapping was performed using the dual-modality radioactive and NIR fluorescence tracer ICG-<sup>99m</sup>Tc-Nanocolloid. All patients underwent combined SLN localization using NIR fluorescence, and the (current) gold standard using blue dye and radioactive guidance.</p></sec><sec id="S3"><title>Results</title><p id="P3">In all 12 patients at least one SLN was detected during surgery. A total of 21 lymph nodes (median 2, range 1 – 3) were resected. Median time between skin incision and first SLN detection was 8 (range 1 – 22) minutes. All resected SLNs were both radioactive and fluorescent, though only 13 of 21 SLN (62%) stained blue. Median brightness of exposed SLNs, expressed as SBR, was 5.4 (range 1.8 – 11.8). Lymph node metastases were found in 3 patients.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">NIR fluorescence guided SLN mapping is feasible and outperforms blue dye staining. Premixing ICG with <sup>99m</sup>Tc-nanocolloid provides real-time intra-operative imaging of the SN and appears the optimal tracer combination in terms of intraoperative detection rate of the SN (100%). Moreover, ICG-<sup>99m</sup>Tc-Nanocolloid allows administration of a 5-times lower injected dose of ICG (compared to ICG and ICG:HSA) and can be injected the up to 20h before surgery.</p></sec></div></front></TEI><affiliations><list><country><li>Pays-Bas</li><li>États-Unis</li></country><region><li>Hollande-Méridionale</li><li>Massachusetts</li></region><settlement><li>Leyde</li></settlement></list><tree><country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Verbeek, Floris P R" sort="Verbeek, Floris P R" uniqKey="Verbeek F" first="Floris P. R." last="Verbeek">Floris P. R. Verbeek</name></region><name sortKey="Gaarenstroom, Katja N" sort="Gaarenstroom, Katja N" uniqKey="Gaarenstroom K" first="Katja N." last="Gaarenstroom">Katja N. Gaarenstroom</name><name sortKey="Peters, Alexander A W" sort="Peters, Alexander A W" uniqKey="Peters A" first="Alexander A. W." last="Peters">Alexander A. W. Peters</name><name sortKey="Rietbergen, Daphne D D" sort="Rietbergen, Daphne D D" uniqKey="Rietbergen D" first="Daphne D. D." last="Rietbergen">Daphne D. D. Rietbergen</name><name sortKey="Schaafsma, Boudewijn E" sort="Schaafsma, Boudewijn E" uniqKey="Schaafsma B" first="Boudewijn E." last="Schaafsma">Boudewijn E. Schaafsma</name><name sortKey="Tummers, Quirijn R J G" sort="Tummers, Quirijn R J G" uniqKey="Tummers Q" first="Quirijn R. J. G." last="Tummers">Quirijn R. J. G. Tummers</name><name sortKey="Vahrmeijer, Alexander L" sort="Vahrmeijer, Alexander L" uniqKey="Vahrmeijer A" first="Alexander L." last="Vahrmeijer">Alexander L. Vahrmeijer</name><name sortKey="Van De Velde, Cornelis J H" sort="Van De Velde, Cornelis J H" uniqKey="Van De Velde C" first="Cornelis J. H." last="Van De Velde">Cornelis J. H. Van De Velde</name><name sortKey="Van Leeuwen, Fijs W B" sort="Van Leeuwen, Fijs W B" uniqKey="Van Leeuwen F" first="Fijs W. B." last="Van Leeuwen">Fijs W. B. Van Leeuwen</name></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Frangioni, John V" sort="Frangioni, John V" uniqKey="Frangioni J" first="John V." last="Frangioni">John V. Frangioni</name></region><name sortKey="Frangioni, John V" sort="Frangioni, John V" uniqKey="Frangioni J" first="John V." last="Frangioni">John V. Frangioni</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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