OBJECTIVE: Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has recently been introduced to improve the sentinel lymph node (SLN) procedure. Several optical tracers have been successfully tested. However, the optimal tracer formulation is still unknown. This study evaluates the performance of ICG-technetium-99m (99mTc)-nanocolloid in relation to 2 most commonly used ICG-based formulas during SLN biopsy in vulvar cancer. METHODS AND MATERIALS: Twelve women who planned to undergo SLN biopsy for stage I vulvar cancer were prospectively included. Sentinel lymph node 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. RESULTS: In all 12 patients, at least 1 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, although only 13 (62%) of 21 SLNs stained blue. Median brightness of exposed SLNs, expressed as signal-to-background ratio, was 5.4 (range, 1.8-11.8). Lymph node metastases were found in 3 patients. CONCLUSIONS: Near-infrared fluorescence-guided SLN mapping is feasible and outperforms blue dye staining. Premixing ICG with 99mTc-nanocolloid provides real-time intraoperative imaging of the SN and seems to be the optimal tracer combination in terms of intraoperative detection rate of the SN (100%). Moreover, ICG-99mTc-nanocolloid allows the administration of a 5-times lower injected dose of ICG (compared with ICG and ICG absorbed to human serum albumin) and can be injected up to 20 hours before surgery.
OBJECTIVE: Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has recently been introduced to improve the sentinel lymph node (SLN) procedure. Several optical tracers have been successfully tested. However, the optimal tracer formulation is still unknown. This study evaluates the performance of ICG-technetium-99m (99mTc)-nanocolloid in relation to 2 most commonly used ICG-based formulas during SLN biopsy in vulvar cancer. METHODS AND MATERIALS: Twelve women who planned to undergo SLN biopsy for stage I vulvar cancer were prospectively included. Sentinel lymph node 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. RESULTS: In all 12 patients, at least 1 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, although only 13 (62%) of 21 SLNs stained blue. Median brightness of exposed SLNs, expressed as signal-to-background ratio, was 5.4 (range, 1.8-11.8). Lymph node metastases were found in 3 patients. CONCLUSIONS: Near-infrared fluorescence-guided SLN mapping is feasible and outperforms blue dye staining. Premixing ICG with 99mTc-nanocolloid provides real-time intraoperative imaging of the SN and seems to be the optimal tracer combination in terms of intraoperative detection rate of the SN (100%). Moreover, ICG-99mTc-nanocolloid allows the administration of a 5-times lower injected dose of ICG (compared with ICG and ICG absorbed to humanserum albumin) and can be injected up to 20 hours before surgery.
Authors: Maaike H Oonk; Bettien M van Hemel; Harry Hollema; Joanne A de Hullu; Anca C Ansink; Ignace Vergote; René H Verheijen; Angelo Maggioni; Katja N Gaarenstroom; Peter J Baldwin; Eleonora B van Dorst; Jacobus van der Velden; Ralph H Hermans; Hans W van der Putten; Pierre Drouin; Ingo B Runnebaum; Wim J Sluiter; Ate G van der Zee Journal: Lancet Oncol Date: 2010-05-25 Impact factor: 41.316
Authors: L M A Crane; G Themelis; H J G Arts; K T Buddingh; A H Brouwers; V Ntziachristos; G M van Dam; A G J van der Zee Journal: Gynecol Oncol Date: 2010-11-06 Impact factor: 5.482
Authors: Joanne A De Hullu; Harry Hollema; Sietske Lolkema; Marike Boezen; Henk Boonstra; Matthe P M Burger; Jan G Aalders; Marian J E Mourits; Ate G J Van Der Zee Journal: Cancer Date: 2002-12-01 Impact factor: 6.860
Authors: Ate G J Van der Zee; Maaike H Oonk; Joanne A De Hullu; Anca C Ansink; Ignace Vergote; René H Verheijen; Angelo Maggioni; Katja N Gaarenstroom; Peter J Baldwin; Eleonore B Van Dorst; Jacobus Van der Velden; Ralph H Hermans; Hans van der Putten; Pierre Drouin; Achim Schneider; Wim J Sluiter Journal: J Clin Oncol Date: 2008-02-20 Impact factor: 44.544
Authors: Jakub Radziszewski; Magdalena Kowalewska; Tomasz Jedrzejczak; Izabella Kozlowicz-Gudzinska; Anna Nasierowska-Guttmejer; Mariusz Bidzinski; Janusz A Siedlecki Journal: Gynecol Oncol Date: 2009-11-17 Impact factor: 5.482
Authors: Susan L Troyan; Vida Kianzad; Summer L Gibbs-Strauss; Sylvain Gioux; Aya Matsui; Rafiou Oketokoun; Long Ngo; Ali Khamene; Fred Azar; John V Frangioni Journal: Ann Surg Oncol Date: 2009-07-07 Impact factor: 5.344
Authors: Ray R Zhang; Alexandra B Schroeder; Joseph J Grudzinski; Eben L Rosenthal; Jason M Warram; Anatoly N Pinchuk; Kevin W Eliceiri; John S Kuo; Jamey P Weichert Journal: Nat Rev Clin Oncol Date: 2017-01-17 Impact factor: 66.675