Lucarelli Richard T, Ogawa Mikako, Kosaka Nobuyuki, Turkbey Baris, Kobayashi Hisataka, Choyke Peter L
Molecular Imaging Program, National Cancer Institute, Bethesda, Maryland 20892, USA.
Lymphat Res Biol. 2009 Dec;7(4):205-14. doi: 10.1089/lrb.2009.0021.
Accurate imaging of the lymphatic system can aid in cancer staging, optimize surgical procedures to reduce lymphedema, and may one day be a means of delivering intralymphatic therapy. The Sentinel Lymph Node (SLN) concept has been pivotal in driving new imaging techniques. Metastasis to a SLN is a critical indicator of advanced disease. However, presently, few tools are available for imaging the lymphatics, and even fewer are available for locating the SLN for biopsy. Recently, new macromolecular agents, including gadolinium-labeled dendrimers, fluorescent quantum dots, and fluorescently-labeled immunoglobins, have been used to image the lymphatics and SLN with MRI and optical techniques, and new fluorescent nanoparticles such as upconverting nanocrystals are potential future agents. Additionally, multi-modality probes combining two modalities such as optical/MR dendrimers have been designed to provide both preoperative imaging, and intraoperative guidance during lymph node resections. These probes can map the lymphatic system for maximal therapeutic benefit while minimizing complications such as lymphedema. Advances in the understanding of the molecular mechanisms of lymphangiogenesis and lymphatic spread of tumors offer the opportunity for more targeted imaging of the lymphatic system. Additionally, these imaging agents could be used as powerful research tools for tracking immunological cells and monitoring the immune response as well as providing the means to deliver lymphatic-targeted therapies. The future holds great promise for the translation of these methods to the clinic.
淋巴系统的精确成像有助于癌症分期，优化手术程序以减少淋巴水肿，并且未来某一天可能成为进行淋巴内治疗的一种手段。前哨淋巴结（SLN）概念在推动新成像技术方面一直起着关键作用。SLN发生转移是疾病进展的关键指标。然而，目前可用于淋巴成像的工具很少，可用于定位SLN进行活检的工具更少。最近，包括钆标记树枝状大分子、荧光量子点和荧光标记免疫球蛋白在内的新型大分子试剂已被用于通过MRI和光学技术对淋巴管和SLN进行成像，并且新型荧光纳米颗粒（如镧系元素掺杂纳米晶）是未来潜在的试剂。此外，已设计出结合光学/MR树枝状大分子等两种模式的多模态探针，以在淋巴结切除术中提供术前成像和术中指导。这些探针可以绘制淋巴系统图，以实现最大治疗益处，同时将淋巴水肿等并发症降至最低。对淋巴管生成和肿瘤淋巴扩散分子机制理解的进展为淋巴系统更具针对性的成像提供了机会。此外，这些成像试剂可用作强大的研究工具，用于追踪免疫细胞和监测免疫反应，以及提供进行淋巴靶向治疗的手段。这些方法转化应用于临床的前景十分广阔。
