Verbeek Floris P R, Tummers Quirijn R J G, Rietbergen Daphne D D, Peters Alexander A W, Schaafsma Boudewijn E, van de Velde Cornelis J H, Frangioni John V, van Leeuwen Fijs W B, Gaarenstroom Katja N, Vahrmeijer Alexander L
Departments of *Surgery and †Radiology, Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, and Department of ‡Gynecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands; and §Department of Radiology and ∥Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Int J Gynecol Cancer. 2015 Jul;25(6):1086-93. doi: 10.1097/IGC.0000000000000419.
Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has recently been introduced to improve the sentinel lymph node (SLN) procedure. Several optical tracers have been successfully tested. However, the optimal tracer formulation is still unknown. This study evaluates the performance of ICG-technetium-99m (99mTc)-nanocolloid in relation to 2 most commonly used ICG-based formulas during SLN biopsy in vulvar cancer.
Twelve women who planned to undergo SLN biopsy for stage I vulvar cancer were prospectively included. Sentinel lymph node mapping was performed using the dual-modality radioactive and NIR fluorescence tracer ICG-99mTc-nanocolloid. All patients underwent combined SLN localization using NIR fluorescence and the (current) gold standard using blue dye and radioactive guidance.
In all 12 patients, at least 1 SLN was detected during surgery. A total of 21 lymph nodes (median 2; range, 1-3) were resected. Median time between skin incision and first SLN detection was 8 (range, 1-22) minutes. All resected SLNs were both radioactive and fluorescent, although only 13 (62%) of 21 SLNs stained blue. Median brightness of exposed SLNs, expressed as signal-to-background ratio, was 5.4 (range, 1.8-11.8). Lymph node metastases were found in 3 patients.
Near-infrared fluorescence-guided SLN mapping is feasible and outperforms blue dye staining. Premixing ICG with 99mTc-nanocolloid provides real-time intraoperative imaging of the SN and seems to be the optimal tracer combination in terms of intraoperative detection rate of the SN (100%). Moreover, ICG-99mTc-nanocolloid allows the administration of a 5-times lower injected dose of ICG (compared with ICG and ICG absorbed to human serum albumin) and can be injected up to 20 hours before surgery.
最近引入了使用吲哚菁绿（ICG）的近红外（NIR）荧光成像技术以改进前哨淋巴结（SLN）手术。几种光学示踪剂已成功进行了测试。然而，最佳的示踪剂配方仍然未知。本研究评估了ICG-锝-99m（99mTc）-纳米胶体在对外阴癌进行SLN活检时相对于2种最常用的基于ICG的配方的性能。
前瞻性纳入12例计划接受I期外阴癌SLN活检的女性。使用双模态放射性和NIR荧光示踪剂ICG-99mTc-纳米胶体进行前哨淋巴结定位。所有患者均采用NIR荧光联合（当前）金标准（蓝色染料和放射性引导）进行SLN定位。
所有12例患者在手术期间均检测到至少1个SLN。共切除21个淋巴结（中位数2个；范围1 - 3个）。皮肤切开至首次检测到SLN的中位时间为8分钟（范围1 - 22分钟）。所有切除的SLN均具有放射性和荧光性，尽管21个SLN中只有13个（62%）染成蓝色。暴露的SLN的中位亮度，以信号与背景比表示，为5.4（范围1.8 - 11.8）。3例患者发现有淋巴结转移。
近红外荧光引导的SLN定位是可行的，并且优于蓝色染料染色。将ICG与99mTc-纳米胶体预混合可提供SN的实时术中成像，就SN的术中检测率（100%）而言似乎是最佳的示踪剂组合。此外，ICG-99mTc-纳米胶体允许注射的ICG剂量比ICG和吸附于人血清白蛋白的ICG低5倍，并且可以在手术前20小时注射。
