Intraoperative multispectral fluorescence imaging for the detection of the sentinel lymph node in cervical cancer: a novel concept.
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.
Crane
Lucia M A
LM
Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
Themelis
George
G
Pleijhuis
Rick G
RG
Harlaar
Niels J
NJ
Sarantopoulos
Athanasios
A
Arts
Henriette J G
HJ
van der Zee
Ate G J
AG
Ntziachristos
Vasilis
V
Vasilis
Ntziachristos
N
van Dam
Gooitzen M
GM
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*