title: Intraoperative multispectral fluorescence imaging for the detection of the sentinel lymph node in cervical cancer: a novel concept.
abstract: OBJECTIVE
  Real-time intraoperative near-infrared fluorescence (NIRF) imaging is a promising technique for lymphatic mapping and sentinel lymph node (SLN) detection. The purpose of this technical feasibility pilot study was to evaluate the applicability of NIRF imaging with indocyanin green (ICG) for the detection of the SLN in cervical cancer.
  
  
  METHODS
  In ten patients with early stage cervical cancer, a mixture of patent blue and ICG was injected into the cervix uteri during surgery. Real-time color and fluorescence videos and images were acquired using a custom-made multispectral fluorescence camera system.
  
  
  RESULTS
  Real-time fluorescence lymphatic mapping was observed in vivo in six patients; a total of nine SLNs were detected, of which one (11%) contained metastases. Ex vivo fluorescence imaging revealed the remaining fluorescent signal in 11 of 197 non-sentinel LNs (5%), of which one contained metastatic tumor tissue. None of the non-fluorescent LNs contained metastases.
  
  
  CONCLUSIONS
  We conclude that lymphatic mapping and detection of the SLN in cervical cancer using intraoperative NIRF imaging is technically feasible. However, the technique needs to be refined for full applicability in cervical cancer in terms of sensitivity and specificity.
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Lucia M A
authors.initials: LM
authors.lastname: Crane
authors.forename: George
authors.initials: G
authors.lastname: Themelis
authors.forename: Rick G
authors.initials: RG
authors.lastname: Pleijhuis
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Harlaar
authors.forename: Athanasios
authors.initials: A
authors.lastname: Sarantopoulos
authors.forename: Henriette J G
authors.initials: HJ
authors.lastname: Arts
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Vasilis
authors.initials: V
authors.lastname: Ntziachristos
authors.forename: Ntziachristos
authors.initials: N
authors.lastname: Vasilis
authors.forename: Gooitzen M
authors.initials: GM
authors.lastname: van Dam
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005453:Fluorescence; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology*