title: Fluorescent iodized emulsion for pre- and intraoperative sentinel lymph node imaging: validation in a preclinical model.
abstract: OBJECTIVE
  To validate the usefulness of a newly developed tracer for preoperative gastric sentinel lymph node (LN) (SLN) mapping and intraoperative navigation after a single preoperative submucosal injection in rat and beagle models.
  
  
  METHODS
  This study was approved by the Experimental Animal Ethical Committee of Yonsei University College of Medicine according to the eighth edition of the Guide for the Care and Use of Laboratory Animals published in 2011. An emulsion was developed that contained indocyanine green in iodized oil, which can be visualized with both computed tomography (CT) and near-infrared (NIR) optical imaging and has the property of delayed washout. This emulsion was injected into the footpad of rats (n = 6) and the gastric submucosa of beagles (n = 8). CT lymphography was performed. The degree of enhancement of popliteal LNs was measured in rats, and the enhancing LNs were identified and the degree of enhancement of the enhancing LNs was measured in beagles. Next, NIR imaging was performed in beagles during open, laparoscopic, and robotic surgery to identify LNs containing the fluorescent signals of indocyanine green. The enhanced LNs detected with CT lymphography and NIR imaging were matched to see if they corresponded.
  
  
  RESULTS
  Preoperative CT lymphography facilitated SLN mapping, and 26 SLNs were identified in eight beagles. NIR imaging enabled high-spatial-resolution visualization of both SLNs and the intervening lymphatic vessels and was useful for intraoperative SLN navigation.
  
  
  CONCLUSIONS
  SLN mapping with fluorescent iodized oil emulsion is effective and feasible for both CT and NIR imaging.
authors.affiliation: From the Department of Radiology (H.K., J.Y., J.S.L.), Research Institute of Radiological Science (H.K., J.S.L.), Gastric Cancer Clinic (H.K., S.K.L., J.S.L., W.J.H.), and Department of Internal Medicine (S.K.L.), Department of Pathology (S.H.K.), YUHS-KRIBB Medical Convergence Research Institute (J.Y.), Department of Surgery (W.J.H.), and Robot and MIS Center (W.J.H.), Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea; Department of Surgery, Bundang CHA Hospital, CHA University College of Medicine, Seongnam, Republic of Korea (Y.M.K.); Department of Bioscience and Bioengineering, Sejong University, Seoul, Republic of Korea (E.H.L., S.J.L.).
authors.forename: Honsoul
authors.initials: H
authors.lastname: Kim
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Yoo Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Eun-Hye
authors.initials: EH
authors.lastname: Lee
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Lim
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Jaemoon
authors.initials: J
authors.lastname: Yang
authors.forename: Joon Seok
authors.initials: JS
authors.lastname: Lim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004655:Emulsions / Q000737:chemistry / Q000493:pharmacokinetics*; D004998:Ethiodized Oil / Q000737:chemistry / Q000493:pharmacokinetics*; D005456:Fluorescent Dyes; D005743:Gastrectomy; D006601:Hexoses / Q000737:chemistry / Q000493:pharmacokinetics; D007430:Intraoperative Care; D010535:Laparoscopy; D008197:Lymph Node Excision; D008220:Lymphography / Q000379:methods*; D008297:Male; D011136:Polysorbates / Q000737:chemistry / Q000493:pharmacokinetics; D011857:Radiographic Image Interpretation, Computer-Assisted; D051381:Rats; D017207:Rats, Sprague-Dawley; D012371:Robotics; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013501:Surface-Active Agents / Q000737:chemistry / Q000493:pharmacokinetics; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D004655:Emulsions; D005456:Fluorescent Dyes; D006601:Hexoses; D011136:Polysorbates; D013501:Surface-Active Agents; D004998:Ethiodized Oil; C005693:sorbitan trioleate