Department of Urology and Robotic Surgery, Research, and Training Center, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
Urology. 2011 Jul;78(1):232.e15-8. doi: 10.1016/j.urology.2011.03.004. Epub 2011 May 23.
To propose that fluorescent molecular imaging has utility in specifically identifying the lymph nodes, thereby enabling more definitive lymph node visualization and dissection. Retroperitoneal lymph node dissection (RPLND) is an invasive procedure with significant morbidity. A minimally invasive approach would be of great clinical benefit but has been limited by the extensive perivascular dissection required to remove all lymphatic tissue. Directed lymph node visualization would allow a limited dissection, making a laparoscopic approach more feasible.
Ten male Hartley guinea pigs underwent nonsurvival RPLND, 5 with the protease activatable in vivo fluorescent molecular imaging agent, ProSense and 5 without image guidance (control). ProSense was administered 24 hours before surgery and detected 24 hours later using a photodynamic detector. In group 1, RPLND was first performed without molecular imaging followed by image-guided lymph node dissection for residual nodes. In group 2, the near infrared detector was used initially for lymph node excision followed by traditionally unassisted extraction of the residual lymph nodes. The lymph nodes were extracted, counted, and sent for histopathologic analysis.
With the assistance of molecular imaging, no additional lymph nodes were identified after complete dissection, and all tissue identified by ProSense was confirmed by histopathologic analysis to be lymph nodes. Without molecular imaging, all lymph nodes were not identified, and in 2 instances, the tissue was incorrectly thought to be lymphatic tissue.
Molecular image-guided RPLND is a promising technique to improve in vivo, live visualization and dissection of lymph nodes and has the potential for application in improving the diagnosis and treatment of other urologic malignancies.
提出荧光分子成像在特异性识别淋巴结方面具有实用性，从而能够更明确地进行淋巴结可视化和解剖。腹膜后淋巴结清扫术（RPLND）是一种具有显著发病率的侵入性手术。微创方法将具有重要的临床益处，但由于需要广泛的血管周围解剖来去除所有的淋巴组织，因此受到限制。定向淋巴结可视化将允许进行有限的解剖，使腹腔镜方法更可行。
10 只雄性 Hartley 豚鼠接受了非生存性 RPLND，其中 5 只使用蛋白酶可激活的活体荧光分子成像剂 ProSense，5 只没有图像引导（对照组）。ProSense 在手术前 24 小时给药，24 小时后使用光动力探测器检测。在第 1 组中，首先进行无分子成像的 RPLND，然后进行图像引导的淋巴结解剖以切除残留的淋巴结。在第 2 组中，最初使用近红外探测器切除淋巴结，然后传统地辅助提取残留的淋巴结。提取、计数淋巴结并进行组织病理学分析。
在分子成像的辅助下，完全解剖后未发现额外的淋巴结，ProSense 识别的所有组织均通过组织病理学分析证实为淋巴结。没有分子成像，所有的淋巴结都没有被识别，在 2 例中，组织被错误地认为是淋巴组织。
分子成像引导的 RPLND 是一种很有前途的技术，可以改善淋巴结的活体可视化和解剖，并有潜力应用于改善其他泌尿科恶性肿瘤的诊断和治疗。
