title: Robotic-assisted fluorescence sentinel lymph node mapping using multimodal image guidance in an animal model.
abstract: OBJECTIVE
  To investigate positron emission tomography/computed tomography (PET/CT) preoperative imaging and intraoperative detection of a fluorescent-labeled receptor-targeted radiopharmaceutical in a prostate cancer animal model.
  
  
  METHODS
  Three male beagle dogs underwent an intraprostatic injection of fluorescent-tagged tilmanocept, radiolabeled with both gallium Ga-68 and technetium Tc-99m. One hour after injection, a pelvic PET/CT scan was performed for preoperative sentinel lymph node (SLN) mapping. The definition of SLN was a standardized uptake value that exceeded 5% of the lymph node with the highest standardized uptake value. Thirty-six hours later, we performed robotic-assisted SLN dissection using a fluorescence-capable camera system. Fluorescent lymph nodes were clipped, the abdomen was opened, and the pelvic and retroperitoneal nodes were excised. All excised nodal packets were assayed by in vitro nuclear counting and reported as the percentage of injected dose.
  
  
  RESULTS
  Preoperative PET/CT imaging identified a median of 3 SLNs per animal. All SLNs (100%) identified by the PET/CT were fluorescent during robotic-assisted lymph node dissection. Of all fluorescent nodes visualized by the camera system, 9 of 12 nodes (75%) satisfied the 5% rule defined by the PET/CT scan. The 2 lymph nodes that did not qualify accumulated <0.002% of the injected dose.
  
  
  CONCLUSIONS
  Fluorescent-labeled tilmanocept has optimal logistic properties to obtain preoperative PET/CT and subsequent real-time intraoperative confirmation during robotic-assisted SLN dissection.
authors.affiliation: Department of Urology, UC San Diego Health System, San Diego, CA; UCSD Moores Cancer Center, La Jolla, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.affiliation: Naval Medical Center San Diego, San Diego, CA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.affiliation: Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA; Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA.
authors.forename: Zhengtao
authors.initials: Z
authors.lastname: Qin
authors.affiliation: UCSD Moores Cancer Center, La Jolla, CA; Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA; Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA.
authors.forename: Carl K
authors.initials: CK
authors.lastname: Hoh
authors.affiliation: UCSD Moores Cancer Center, La Jolla, CA; Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hall
authors.affiliation: UCSD Moores Cancer Center, La Jolla, CA; Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA; Department of Surgery, University of California, San Diego, La Jolla, CA.
authors.forename: David R
authors.initials: DR
authors.lastname: Vera
authors.affiliation: Department of Urology, UC San Diego Health System, San Diego, CA; UCSD Moores Cancer Center, La Jolla, CA; Department of Surgery, University of California, San Diego, La Jolla, CA. Electronic address: ckane@ucsd.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
mesh_terms: D000818:Animals; D003911:Dextrans; D004195:Disease Models, Animal; D004285:Dogs; D061705:Image-Guided Biopsy; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D019275:Radiopharmaceuticals; D065287:Robotic Surgical Procedures; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016284:Technetium Tc 99m Pentetate / Q000031:analogs & derivatives*; D014057:Tomography, X-Ray Computed
chemical_list: D003911:Dextrans; D019275:Radiopharmaceuticals; C577481:gallium-diethylenetriaminepentaacetic acid-mannosyl-dextran; D016284:Technetium Tc 99m Pentetate