Hirche Christoph, Engel Holger, Hirche Zarah, Doniga Sergiu, Herold Thomas, Kneser Ulrich, Lehnhardt Marcus, Hünerbein Michael
From the *Department of Hand, Plastic, and Reconstructive Surgery, Trauma Centre Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany; †Department of General Surgery and Surgical Oncology, Helios Hospital Berlin-Buch, Berlin, Germany; and ‡Department of Radiology, Helios Hospital Berlin-Buch, Berlin, Germany.
Ann Plast Surg. 2014 Dec;73(6):701-5. doi: 10.1097/SAP.0b013e3182858831.
Lymphatic imaging is an important step for the identification of lymphonodal positive disease in solid malignancies. Various methods have been established to detect positive lymph nodes, but the available diagnostic tools leave some inherent drawbacks. The aim of this study was to validate the indocyanine green (ICG) guided approach for transcutaneous and transmesenterial navigation with accurate lymph vessel and node identification for regional lymph node staging in solid malignancies.
After institutional review board approval, a planar fluorescence imaging system was applied for lymphography and lymph node detection using ICG. A total of 96 patients were recruited and subject to fluorescence navigation for axillary (n = 46), inguinal (n = 16), and mesenterial (n = 34) visualization to analyze technical and clinical feasibility of the method after regional lymph node dissection and the applicability.
Overall fluorescence imaging identified lymphatic vessels and the SLN in 92 out of 96 patients (detection rate: 96%) after a mean injection of 7 mg ICG. Sensitivity based on fluorescent emission of ICG navigation was 95.6% in 65 out of 68 patients with lymph node dissection. All solid tumors were feasible for fluorescence-guided navigation with a broad spectrum.
Fluorescence-guided real-time lymphography with navigation to regional lymph nodes enables accurate visualization for a broad spectrum of different solid tumors with potential lymphonodal spread. In addition, the technique can be applied for lymphography in non-malignant diseases. With reference to the broad application spectrum, institutional investment in camera equipment can be justified.
淋巴成像对于实体恶性肿瘤中淋巴结阳性疾病的识别是重要步骤。已建立多种方法来检测阳性淋巴结，但现有的诊断工具存在一些固有缺陷。本研究的目的是验证吲哚菁绿（ICG）引导的经皮和经肠系膜导航方法，用于准确识别淋巴管和淋巴结，以进行实体恶性肿瘤的区域淋巴结分期。
经机构审查委员会批准后，使用平面荧光成像系统进行淋巴造影和使用ICG检测淋巴结。共招募了96例患者，对腋窝（n = 46）、腹股沟（n = 16）和肠系膜（n = 34）进行荧光导航可视化，以分析区域淋巴结清扫术后该方法的技术和临床可行性以及适用性。
平均注射7 mg ICG后，96例患者中有92例通过整体荧光成像识别出淋巴管和前哨淋巴结（检测率：96%）。在68例进行淋巴结清扫的患者中，基于ICG导航荧光发射的敏感性为95.6%。所有实体肿瘤均可通过荧光引导导航，适用范围广泛。
荧光引导的实时淋巴造影及区域淋巴结导航能够对广泛的不同实体肿瘤进行准确可视化，这些肿瘤可能发生淋巴结转移。此外，该技术可应用于非恶性疾病的淋巴造影。鉴于其广泛的应用范围，机构对摄像设备的投资是合理的。
