Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green

Hirche, Christoph; Mohr, Z.; Kneif, Sören; Doniga, Sergiu; Murawa, Dawid; Strik, M. W.; Hünerbein, M.

doi:10.1007/s00384-011-1306-5

Cited by 107 publications

(80 citation statements)

References 34 publications

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“…FI may offer better tissue contrast, facilitating detection in deep anatomic regions such as the abdomen, and is easy and safe to perform (13,14,17). Furthermore, ICG-FI is not influenced by the patient's BMI nor by lymphatic invasion, as has been shown for conventional methods, and has been shown to increase SLN detection in comparison with standard techniques (16,18).…”

Section: Discussionmentioning

confidence: 95%

“…ICG-FI has emerged as a promising new imaging technique for in vivo detection of SLNs of colorectal origin (13,14). FI may offer better tissue contrast, facilitating detection in deep anatomic regions such as the abdomen, and is easy and safe to perform (13,14,17).…”

Section: Discussionmentioning

confidence: 99%

“…Only few studies have evaluated FI in CRC (13)(14)(15)(16). These studies have shown a potential advantage of FI compared to classical blue dye and lymphoscintigraphy techniques for the detection of deep LN, particularly in obese patients (16).…”

Section: Colorectal Cancer (Crc) To Determine Which Patients Should Rmentioning

confidence: 99%

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Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Liberale

Vankerckhove

Galdón

et al. 2016

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Abstract. Background In patients with colorectal cancer (CRC), the accurate establishment of the pathological status of tumor-draining mesenteric lymph nodes (LN) is of central importance for therapeutic management. In patients with stage III disease with demonstrated LN metastases, adjuvant systemic chemotherapy is indicated, reducing the risk of recurrence and improving long-term overall survival (1). The accuracy of mesenteric nodal staging depends primarily on the number of resected LN, and the seventh American Joint Committee on Cancer (AJCC) edition recommends harvesting and analysis of at least 12 to 14 LN for correct staging (2). Despite this, 20-30% of patients with no LN metastases demonstrated at pathology (pN0), and therefore classified as stage II, still develop recurrent disease (3). These recurrences could potentially be associated with unrecognized locoregional nodal metastases, which could lead to understaging and undertreatment.The sentinel lymph node (SLN) is defined as the first LN draining the primary tumor. In melanoma and breast cancer, it has been shown that pathological status of the SLN is indicative of the risk of nodal metastases, thus providing an indication for lymphadenectomy when SLN pathological examination is positive and for avoiding mutilating surgery when it is negative (4, 5). The concept, and potential utility, of the SLN is different in CRC since mesenteric lymphadenectomy is systematically performed during surgery for the primary tumor. In patients with CRC, the particular contribution of SLN examination could be to focus the pathological analysis specifically on draining LNs in order to improve the sensitivity for cancer cell detection by the use of advanced methods, such as serial sectioning, immunohistochemistry (IHC), and molecular analyses such as reverse transcriptase polymerase chain reaction (RT-PCR) to increase pathological staging (6).Accordingly, a recent meta-analysis concluded that the use of SLN examination allowed for nodal up-staging of patients with CRC, providing a potential benefit (7). However, the technique of SLN analysis is still not widely used in patients with CRC. This could be related to the variability of the sensitivity of techniques for SLN detection which ranges from 33% to 100%, to the risk of missed metastases, and also to uncertainty related to the clinical significance and prognostic value of nodal micrometastases in CRC (7-9).Recently, fluorescence imaging (FI) using indocyanine green (ICG) has emerged as a new technique for SLN detection in various tumors (10)(11)(12). Only few studies have 4853

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Liberale

Vankerckhove

Galdón

et al. 2016

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“…8 In addition, the SLN detection with ICG has been successfully reported in various cancers where lymphatic flows are multidirectional and complex, e.g., gastric cancer [18][19][20][21] and colorectal cancer, 22,23 as well as in different gynecological cancer types located in vulva, [24][25][26] cervix, 9,25,27 or endometrium. [28][29][30] To our knowledge, there are several investigational devices used for clinical trials of ICG fluorescence imaging of SLNs in humans: the Photodynamic Eye from Hamamatsu, 11,19 the ICView from Pulsion Medical Systems, 10,23 the FLARE system developed at Beth Israel Deaconess Hospital in Boston, Massachusetts, 6 a prototype developed at the Helmholtz Zentrum of the Technical University Munich, Germany, 31 the SPY imaging system (Novadaq Technologies Inc., USA), 17 the low-cost ICG fluorescence detection system built at University of Tsukuba in Japan, 32 and the frequency-domain photon migration imaging system developed at the University of Texas Health Science Center in Houston, Texas. 14,33 In addition, Hirche et al 34 used domestic pigs to evaluate the feasibility of the Fluobeam 800 imaging system (Fluoptics, Grenoble, France) for lymphatic imaging, whereas van Driel et al 35 have recently reported the first in-human study performed with the Artemis (Quest Medical Imaging BV, The Netherlands) imaging system where colorectal liver metastases were visualized with ICG.…”

Section: Introductionmentioning

confidence: 99%

Development of a handheld fluorescence imaging camera for intraoperative sentinel lymph node mapping

et al. 2015

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Abstract. We present a compact fluorescence imaging system developed for real-time sentinel lymph node mapping. The device uses two near-infrared wavelengths to record fluorescence and anatomical images with a single charge-coupled device camera. Experiments on lymph node and tissue phantoms confirmed that the amount of dye in superficial lymph nodes can be better estimated due to the absorption correction procedure integrated in our device. Because of the camera head's small size and low weight, all accessible regions of tissue can be reached without the need for any adjustments.

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“…In particular, ICG was approved for use in indicator-dilution studies by the FDA in 1958, and it is known to be one of the least toxic agents ever administered to humans, with the only known adverse reaction being rare anaphylaxis [13]. ICG emits an 800-to 840-nm fluorescence signal, has been applied in several malignancies, such as breast [14][15][16], colon [17,18], and vulva cancers [19], and has been reported to be more sensitive than infrared imaging in gastric cancer [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the novel near-infrared fluorescence tracers pullulan polymer nanogel and indocyanine green/γ-glutamic acid complex for sentinel lymph node navigation surgery in large animal models

et al. 2014

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Background This study aimed to examine tracers designed to overcome the disadvantages of indocyanine green (ICG), which disperses quickly to multiple lymph nodes, using a near-infrared (NIR) imaging system in animal models. Methods Diluted ICG, ICG/poly-c-glutamic acid (PGA) complex, and IRDye900-conjugated pullulan-cholesterol nanoprobe ''near-infrared polynagogel'' (NIR-PNG) were injected into the stomachs of dogs and pigs, and the patterns of dispersion were observed using an NIR imaging system. To compare retention times, fluorescence signals were evaluated in the stomach and small bowel of animals 1 week after injection.Results A diluted concentration (*0.1 mg/ml) of ICG was optimal for NIR imaging compared with the conventional concentration (5 mg/ml) for visual inspection. When injected into the stomach, the signals of ICG and ICG/PGA complex were relatively large at the injection site, and signals were detected at multiple sentinel nodes and lymph nodes beyond them. The NIR-PNG signal intensity was relatively small at the injection site and limited to only one sentinel node with no additional node. When evaluated 1 week after injection, only the NIR-PNG signal was detected in the canine stomach, and the signal intensity at the lymph nodes of the porcine small bowel was the highest with NIR-PNG, followed by ICG/PGA complex and finally ICG. Conclusion NIR-PNG showed the best characteristics of less dispersion and longer retention in the sentinel nodes, and ICG/PGA complex remained longer than diluted ICG. These tracers could potentially be used as optimal tracers for sentinel node navigation surgery in gastric cancer.

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Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green

Cited by 107 publications

References 34 publications

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Development of a handheld fluorescence imaging camera for intraoperative sentinel lymph node mapping

Evaluation of the novel near-infrared fluorescence tracers pullulan polymer nanogel and indocyanine green/γ-glutamic acid complex for sentinel lymph node navigation surgery in large animal models

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