title: Optimization of sentinel lymph node mapping in bladder cancer using near-infrared fluorescence imaging.
abstract: OBJECTIVE
  Unlike other cancers, the Sentinel Lymph Node (SLN) procedure in bladder cancer requires special attention to the injection technique. The aim of this study was to assess feasibility and to optimize tracer injection technique for SLN mapping in bladder cancer patients using NIR fluorescence imaging.
  
  
  METHODS
  Twenty patients with invasive bladder cancer scheduled for radical cystectomy were prospectively enrolled. Indocyanine green (ICG) bound to human serum albumin (complex ICG:HSA; 500 µM) was injected peritumourally to permit SLN mapping. ICG:HSA was first administrated serosally (n = 5), and subsequently mucosally by cystoscopic injection (n = 15). In the last cohort of 12 patients treated with cystoscopic injection, the bladder was kept filled with saline for at least 15 min.
  
  
  RESULTS
  Fluorescent lymph nodes were observed only in the patient group with cystoscopic injection of ICG:HSA. Filling of the bladder post-injection was of added value to promote drainage of ICG:HSA to the lymph nodes, and in 11 of these 12 patients (92%) one or more NIR fluorescent lymph nodes were identified.
  
  
  CONCLUSIONS
  The current study demonstrates proof-of-principle of using NIR fluorescence imaging for SLN identification in bladder cancer. Cystoscopic injection with distension of the bladder appears optimal for SLN mapping.
authors.affiliation: Departments of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: B E
authors.initials: BE
authors.lastname: Schaafsma
authors.forename: F P R
authors.initials: FP
authors.lastname: Verbeek
authors.forename: H W
authors.initials: HW
authors.lastname: Elzevier
authors.forename: Q R J G
authors.initials: QR
authors.lastname: Tummers
authors.forename: J R
authors.initials: JR
authors.lastname: van der Vorst
authors.forename: J V
authors.initials: JV
authors.lastname: Frangioni
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: R C M
authors.initials: RC
authors.lastname: Pelger
authors.forename: A L
authors.initials: AL
authors.lastname: Vahrmeijer
mesh_terms: D000368:Aged; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: Bladder Cancer; Fluorescence Imaging; Image-Guided Surgery; Indocyanine Green; Sentinel Lymph Node
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