Simultaneous Mapping of Pan and Sentinel Lymph Nodes for Real-Time Image-Guided Surgery

The resection of regional lymph nodes in the basin of a primary tumor is of paramount importance in surgical oncology. Although sentinel lymph node mapping is now the standard of care in breast cancer and melanoma, over 20% of patients require a completion lymphadenectomy. Yet, there is currently no...

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Published inTheranostics Vol. 4; no. 7; pp. 693 - 700
Main Authors Ashitate, Yoshitomo, Hyun, Hoon, Kim, Soon Hee, Lee, Jeong Heon, Henary, Maged, Frangioni, John V., Choi, Hak Soo
Format Journal Article
LanguageEnglish
Published Australia Ivyspring International Publisher 01.01.2014
Subjects
Animals
Fluorescent Dyes - chemistry
Fluorescent Dyes - pharmacokinetics
Lymph Nodes - drug effects
Lymph Nodes - surgery
Male
Microscopy, Fluorescence - methods
Optical Imaging - methods
Rats
Rats, Sprague-Dawley
Research Paper
Surgery, Computer-Assisted - methods
Swine
image-guided surgery
completion lymphadenectomy
pan lymph node mapping
sentinel lymph node mapping
cervical cancer
Near-infrared fluorescence
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Summary:The resection of regional lymph nodes in the basin of a primary tumor is of paramount importance in surgical oncology. Although sentinel lymph node mapping is now the standard of care in breast cancer and melanoma, over 20% of patients require a completion lymphadenectomy. Yet, there is currently no technology available that can image all lymph nodes in the body in real time, or assess both the sentinel node and all nodes simultaneously. In this study, we report an optical fluorescence technology that is capable of simultaneous mapping of pan lymph nodes (PLNs) and sentinel lymph nodes (SLNs) in the same subject. We developed near-infrared fluorophores, which have fluorescence emission maxima either at 700 nm or at 800 nm. One was injected intravenously for identification of all regional lymph nodes in a basin, and the other was injected locally for identification of the SLN. Using the dual-channel FLARE intraoperative imaging system, we could identify and resect all PLNs and SLNs simultaneously. The technology we describe enables simultaneous, real-time visualization of both PLNs and SLNs in the same subject.
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These authors contributed equally to this work.
Conflict of Interest: FLARE™ technology is owned by Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. It has been licensed to the FLARE Foundation, a non-profit organization focused on promoting the dissemination of medical imaging technology for research and clinical use. Dr. Frangioni is the founder and chairman of the FLARE Foundation. The Beth Israel Deaconess Medical Center will receive royalties for sale of FLARE™ Technology. Dr. Frangioni has elected to surrender post-market royalties to which he would otherwise be entitled as inventor, and has elected to donate pre-market proceeds to the FLARE Foundation. Dr. Frangioni has started three for-profit companies, Curadel, Curadel ResVet Imaging, and Curadel Surgical Innovations, which may someday be non-exclusive sub-licensees of FLARE™ technology.
ISSN:1838-7640
1838-7640
DOI:10.7150/thno.8721