title: Sentinel Lymph Node Mapping of Liver.
abstract: BACKGROUND
  Although the sentinel lymph node (SLN) hypothesis has been applied to many tissues and organs, liver has remained unstudied. Currently, it is unclear whether hepatic SLNs even exist. If so, they could alter the management of intrahepatic cholangiocarcinoma and other hepatic malignancies by minimizing the extent of surgery while still providing precise nodal staging. This study investigated whether invisible yet tissue-penetrating near-infrared (NIR) fluorescent light can provide simultaneous identification of both the SLN and all other regional lymph nodes (RLNs) in the liver.
  
  
  METHODS
  In 25 Yorkshire pigs, this study determined whether SLNs exist in liver and compared the effectiveness of two clinically available NIR fluorophores [methylene blue and indocyanine green (ICG)], and two novel NIR fluorophores previously described by our group (ESNF14 and ZW800-3C) for SLN and RLN mapping.
  
  
  RESULTS
  In this study, ESNF14 showed the highest signal-to-background ratio and the longest retention time in SLNs without leakage to second-tier lymph nodes. The findings showed that ICG had apparent leakage to second-tier nodes, and ZW800-3C had poor migration after intraparenchymal injection. However, when injected intravenously, ZW800-3C was able to highlight all RLNs in liver during a 4- to 6-h period. Simultaneous dual-channel imaging of SLN (ESNF14) and RLN (ZW800-3C) permitted unambiguous identification and image-guided resection of SLNs and RLNs in liver.
  
  
  CONCLUSIONS
  The NIR imaging technology enables real-time intraoperative identification of SLNs and RLNs in the liver of swine. If these results are confirmed in patients, new strategies for the surgical management of intrahepatic malignancies should be possible.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Hoon
authors.initials: H
authors.lastname: Hyun
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Vargas
authors.affiliation: Department of Pathology and Laboratory Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Genega
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|INSERM, CRI, U823, Institut Albert Bonniot, Grenoble, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Gravier
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Gioux
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Curadel, LLC, Worcester, MA, USA.|Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. hchoi@bidmc.harvard.edu.
authors.forename: Hak Soo
authors.initials: HS
authors.lastname: Choi
mesh_terms: D000818:Animals; D004396:Coloring Agents; D005260:Female; D005456:Fluorescent Dyes; D007208:Indocyanine Green; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000378:metabolism; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D019265:Spectroscopy, Near-Infrared; D013552:Swine
chemical_list: D004396:Coloring Agents; D005456:Fluorescent Dyes; D007208:Indocyanine Green