In vivo optical imaging of pleural space drainage to lymph nodes of prognostic significance.
BACKGROUND
Understanding the spatial and temporal drainage patterns of the pleural space could have profound impact on the treatment of lung cancer and mesothelioma. The purpose of this study was to identify the in vivo pattern of drainage from the pleural space to prognostic lymph node stations.


METHODS
Fifty-six rats underwent pleural space injection of a novel lymph tracer composed of recombinant human serum albumin (HSA) covalently conjugated to the near-infrared (NIR) fluorophore IRDye78 via an amide bond (HSA-78). Nodal uptake was imaged at 10, 20, 30, and 60 minutes and 4, 12, and 24 hours after injection with a custom system that simultaneously acquires color video, NIR fluorescence of HSA-78, and a merged picture of the two. Six pigs underwent the same procedure with imaging at 30 minutes, 1 hour, and 24 hours.


RESULTS
In both the rat model and the pig model, HSA-78 drained from the pleural space to superior mediastinal lymph nodes first, followed by other intrathoracic and then extrathoracic lymph nodes over the course of 24 hours.


CONCLUSIONS
NIR fluorescence imaging in two species shows that the superior mediastinal lymph nodes are the first to drain the pleural space. Over the course of 24 hours, the pleural space also communicates with other intrathoracic and then extrathoracic lymph nodes. This study also demonstrates an intraoperative method for identifying nodes communicating with the pleural space, with potential utility in the staging and/or resection of lung cancer and mesothelioma.
Parungo
Cherie P
CP
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Ohnishi
Shunsuke
S
De Grand
Alec M
AM
Laurence
Rita G
RG
Soltesz
Edward G
EG
Colson
Yolonda L
YL
Kang
Peter M
PM
Mihaljevic
Tomislav
T
Cohn
Lawrence H
LH
Frangioni
John V
JV
D000818:Animals; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000033:anatomy & histology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008208:Lymphatic System / Q000033:anatomy & histology; D061305:Lymphoscintigraphy; D008297:Male; D008654:Mesothelioma / Q000473:pathology*; D035422:Pleural Cavity / Q000033:anatomy & histology*; D010997:Pleural Neoplasms / Q000473:pathology*; D011379:Prognosis; D051381:Rats; D017207:Rats, Sprague-Dawley; D012709:Serum Albumin; D013552:Swine
D012709:Serum Albumin