Toward Optimization of Imaging System and Lymphatic Tracer for Near-Infrared Fluorescent Sentinel Lymph Node Mapping in Breast Cancer

Autor: Clemens W.G.M. Löwik, Alexander L. Vahrmeijer, Summer L. Gibbs-Strauss, Rafiou Oketokoun, Gerrit-Jan Liefers, Hak Soo Choi, Susan Troyan, Long Ngo, Joost R. van der Vorst, Alan Stockdale, Yoshitomo Ashitate, J. Sven D. Mieog, Peter J. K. Kuppen, Merlijn Hutteman, Cornelis J.H. van de Velde, Hein Putter, Kevin J. Donohoe, Sylvain Gioux, John V. Frangioni, Vincent T.H.B.M. Smit
Jazyk: angličtina
Předmět:
Pathology
Swine
medicine.medical_treatment
Pilot Projects
chemistry.chemical_compound
0302 clinical medicine
indocyanine green fluorescence guided surgery biopsy identification dissection navigation trial
Image Processing
Computer-Assisted
Medicine
Coloring Agents
Aged
80 and over
Spectroscopy
Near-Infrared
Carcinoma
Ductal
Breast
Middle Aged
Prognosis
Fluorescence
3. Good health
Lymphatic system
Oncology
Lymphatic Metastasis
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Adult
Indocyanine Green
medicine.medical_specialty
Breast surgery
Sentinel lymph node
Breast Neoplasms
Breast Oncology
03 medical and health sciences
Breast cancer
Animals
Humans
Radionuclide Imaging
Aged
Lymphatic Vessels
Sentinel Lymph Node Biopsy
business.industry
Near-infrared spectroscopy
technology
industry
and agriculture
Axillary Lymph Node Dissection
medicine.disease
body regions
Carcinoma
Lobular
Carcinoma
Intraductal
Noninfiltrating
chemistry
Surgery
Lymph Nodes
Radiopharmaceuticals
business
Nuclear medicine
Indocyanine green
Zdroj: Annals of Surgical Oncology
Annals of Surgical Oncology, 18(9), 2483-2491
ISSN: 1068-9265
DOI: 10.1245/s10434-011-1566-x
Popis: Background Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers. Materials and Methods A small, portable version of the FLARE imaging system, termed Mini-FLARE, was developed for capturing color video and two semi-independent channels of NIR fluorescence (700 and 800 nm) in real time. Initial optimization of lymphatic tracer dose was performed using 35-kg Yorkshire pigs and a 6-patient pilot clinical trial. More refined optimization was performed in 24 consecutive breast cancer patients. All patients received the standard of care using 99mTechnetium-nanocolloid and patent blue. In addition, 1.6 ml of indocyanine green adsorbed to human serum albumin (ICG:HSA) was injected directly after patent blue at the same location. Patients were allocated to 1 of 8 escalating ICG:HSA concentration groups from 50 to 1000 μM. Results The Mini-FLARE system was positioned easily in the operating room and could be used up to 13 in. from the patient. Mini-FLARE enabled visualization of lymphatic channels and SLNs in all patients. A total of 35 SLNs (mean = 1.45, range 1–3) were detected: 35 radioactive (100%), 30 blue (86%), and 35 NIR fluorescent (100%). Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN. Optimal injection dose of ICG:HSA ranged between 400 and 800 μM. No adverse reactions were observed. Conclusions We describe the clinical translation of a new NIR fluorescence imaging system and define the optimal ICG:HSA dose range for SLN mapping in breast cancer. Electronic supplementary material The online version of this article (doi:10.1245/s10434-011-1566-x) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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