title: Simultaneous mapping of pan and sentinel lymph nodes for real-time image-guided surgery.
abstract: The resection of regional lymph nodes in the basin of a primary tumor is of paramount importance in surgical oncology. Although sentinel lymph node mapping is now the standard of care in breast cancer and melanoma, over 20% of patients require a completion lymphadenectomy. Yet, there is currently no technology available that can image all lymph nodes in the body in real time, or assess both the sentinel node and all nodes simultaneously. In this study, we report an optical fluorescence technology that is capable of simultaneous mapping of pan lymph nodes (PLNs) and sentinel lymph nodes (SLNs) in the same subject. We developed near-infrared fluorophores, which have fluorescence emission maxima either at 700 nm or at 800 nm. One was injected intravenously for identification of all regional lymph nodes in a basin, and the other was injected locally for identification of the SLN. Using the dual-channel FLARE intraoperative imaging system, we could identify and resect all PLNs and SLNs simultaneously. The technology we describe enables simultaneous, real-time visualization of both PLNs and SLNs in the same subject.
authors.affiliation: 1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA ; 2. Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Ashitate
authors.affiliation: 1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Hoon
authors.initials: H
authors.lastname: Hyun
authors.affiliation: 1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Soon Hee
authors.initials: SH
authors.lastname: Kim
authors.affiliation: 1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Jeong Heon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: 3. Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA.
authors.forename: Maged
authors.initials: M
authors.lastname: Henary
authors.affiliation: 1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA ; 4. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
authors.affiliation: 1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA ; 5. Department of Cogno-Mechatronics Engineering, Pusan National University, Busan 609-735, South Korea.
authors.forename: Hak Soo
authors.initials: HS
authors.lastname: Choi
mesh_terms: D000818:Animals; D005456:Fluorescent Dyes / Q000737:chemistry / Q000493:pharmacokinetics*; D008198:Lymph Nodes / Q000187:drug effects / Q000601:surgery*; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods*; D061848:Optical Imaging / Q000379:methods*; D051381:Rats; D017207:Rats, Sprague-Dawley; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine
chemical_list: D005456:Fluorescent Dyes
keywords: Near-infrared fluorescence; cervical cancer.; completion lymphadenectomy; image-guided surgery; pan lymph node mapping; sentinel lymph node mapping