Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Identifieur interne : 003F46 ( Ncbi/Curation ); précédent : 003F45; suivant : 003F47Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Auteurs : Lucia M. A. Crane ; George Themelis ; K. Tim Buddingh ; Niels J. Harlaar ; Rick G. Pleijhuis ; Athanasios Sarantopoulos ; Ate G. J. Van Der Zee ; Vasilis Ntziachristos ; Gooitzen M. Van DamSource :
- Journal of Visualized Experiments : JoVE [ 1940-087X ] ; 2010.
Descripteurs français
- KwdFr :
- Biopsie de noeud lymphatique sentinelle (), Biopsie de noeud lymphatique sentinelle (instrumentation), Colorants fluorescents (), Femelle, Humains, Noeuds lymphatiques (anatomopathologie), Spectrométrie de fluorescence (), Spectrométrie de fluorescence (instrumentation), Tumeurs de la vulve (anatomopathologie), Tumeurs de la vulve (diagnostic), Tumeurs du col de l'utérus (anatomopathologie), Tumeurs du col de l'utérus (diagnostic), Vert indocyanine ().
- MESH :
English descriptors
- KwdEn :
- Female, Fluorescent Dyes (chemistry), Humans, Indocyanine Green (chemistry), Lymph Nodes (pathology), Sentinel Lymph Node Biopsy (instrumentation), Sentinel Lymph Node Biopsy (methods), Spectrometry, Fluorescence (instrumentation), Spectrometry, Fluorescence (methods), Uterine Cervical Neoplasms (diagnosis), Uterine Cervical Neoplasms (pathology), Vulvar Neoplasms (diagnosis), Vulvar Neoplasms (pathology).
- MESH :
- chemical , chemistry : Fluorescent Dyes, Indocyanine Green.
- diagnosis : Uterine Cervical Neoplasms, Vulvar Neoplasms.
- instrumentation : Sentinel Lymph Node Biopsy, Spectrometry, Fluorescence.
- methods : Sentinel Lymph Node Biopsy, Spectrometry, Fluorescence.
- pathology : Lymph Nodes, Uterine Cervical Neoplasms, Vulvar Neoplasms.
- Female, Humans.
Abstract
The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.
Url:
DOI: 10.3791/2225
PubMed: 21048667
PubMed Central: 3185642
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Lucia M. A. Crane<affiliation><nlm:aff id="ID1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen</nlm:aff>
<wicri:noCountry code="subfield">University Medical Center Groningen</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="ID2">Helmholtz Zentrum, Technical University Munich</nlm:aff>
<wicri:noCountry code="subfield">Technical University Munich</wicri:noCountry>
</affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology</title>
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<affiliation><nlm:aff id="ID1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen</nlm:aff>
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<author><name sortKey="Themelis, George" sort="Themelis, George" uniqKey="Themelis G" first="George" last="Themelis">George Themelis</name>
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<author><name sortKey="Buddingh, K Tim" sort="Buddingh, K Tim" uniqKey="Buddingh K" first="K. Tim" last="Buddingh">K. Tim Buddingh</name>
<affiliation><nlm:aff id="ID1">Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen</nlm:aff>
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<author><name sortKey="Harlaar, Niels J" sort="Harlaar, Niels J" uniqKey="Harlaar N" first="Niels J." last="Harlaar">Niels J. Harlaar</name>
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<wicri:noCountry code="subfield">University Medical Center Groningen</wicri:noCountry>
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<author><name sortKey="Pleijhuis, Rick G" sort="Pleijhuis, Rick G" uniqKey="Pleijhuis R" first="Rick G." last="Pleijhuis">Rick G. Pleijhuis</name>
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<author><name sortKey="Sarantopoulos, Athanasios" sort="Sarantopoulos, Athanasios" uniqKey="Sarantopoulos A" first="Athanasios" last="Sarantopoulos">Athanasios Sarantopoulos</name>
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<author><name sortKey="Ntziachristos, Vasilis" sort="Ntziachristos, Vasilis" uniqKey="Ntziachristos V" first="Vasilis" last="Ntziachristos">Vasilis Ntziachristos</name>
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<series><title level="j">Journal of Visualized Experiments : JoVE</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Female</term>
<term>Fluorescent Dyes (chemistry)</term>
<term>Humans</term>
<term>Indocyanine Green (chemistry)</term>
<term>Lymph Nodes (pathology)</term>
<term>Sentinel Lymph Node Biopsy (instrumentation)</term>
<term>Sentinel Lymph Node Biopsy (methods)</term>
<term>Spectrometry, Fluorescence (instrumentation)</term>
<term>Spectrometry, Fluorescence (methods)</term>
<term>Uterine Cervical Neoplasms (diagnosis)</term>
<term>Uterine Cervical Neoplasms (pathology)</term>
<term>Vulvar Neoplasms (diagnosis)</term>
<term>Vulvar Neoplasms (pathology)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle ()</term>
<term>Biopsie de noeud lymphatique sentinelle (instrumentation)</term>
<term>Colorants fluorescents ()</term>
<term>Femelle</term>
<term>Humains</term>
<term>Noeuds lymphatiques (anatomopathologie)</term>
<term>Spectrométrie de fluorescence ()</term>
<term>Spectrométrie de fluorescence (instrumentation)</term>
<term>Tumeurs de la vulve (anatomopathologie)</term>
<term>Tumeurs de la vulve (diagnostic)</term>
<term>Tumeurs du col de l'utérus (anatomopathologie)</term>
<term>Tumeurs du col de l'utérus (diagnostic)</term>
<term>Vert indocyanine ()</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="chemistry" xml:lang="en"><term>Fluorescent Dyes</term>
<term>Indocyanine Green</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Noeuds lymphatiques</term>
<term>Tumeurs de la vulve</term>
<term>Tumeurs du col de l'utérus</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Uterine Cervical Neoplasms</term>
<term>Vulvar Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Tumeurs de la vulve</term>
<term>Tumeurs du col de l'utérus</term>
</keywords>
<keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Sentinel Lymph Node Biopsy</term>
<term>Spectrometry, Fluorescence</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Sentinel Lymph Node Biopsy</term>
<term>Spectrometry, Fluorescence</term>
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<term>Uterine Cervical Neoplasms</term>
<term>Vulvar Neoplasms</term>
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<front><div type="abstract" xml:lang="en"><p>The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.<sup>1-3</sup>
Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.<sup>4,5</sup>
As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.<sup>6</sup>
In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.<sup>7</sup>
The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.</p>
<p>Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.<sup>8</sup>
It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.<sup>9</sup>
.</p>
<p>The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.</p>
</div>
</front>
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