Kogashiwa Yasunao, Sakurai Hiroyuki, Akimoto Yoshihiro, Sato Dai, Ikeda Tetsuya, Matsumoto Yoshifumi, Moro Yorihisa, Kimura Toru, Hamanoue Yasuhiro, Nakamura Takehiro, Yamauchi Koichi, Saito Koichiro, Sugasawa Masashi, Kohno Naoyuki
Department of Head and Neck Surgery, Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Department of Pharmacology and Toxycology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
PLoS One. 2015 Jul 10;10(7):e0132511. doi: 10.1371/journal.pone.0132511. eCollection 2015.
Sentinel node navigation surgery is gaining popularity in oral cancer. We assessed application of sentinel lymph node navigation surgery to pharyngeal and laryngeal cancers by evaluating the combination of contrast-enhanced ultrasonography and indocyanine green fluorescence in animal models.
This was a prospective, nonrandomized, experimental study in rabbit and swine animal models. A mixture of indocyanine green and Sonazoid was used as the tracer. The tracer mixture was injected into the tongue, larynx, or pharynx. The sentinel lymph nodes were identified transcutaneously by infra-red camera and contrast-enhanced ultrasonography. Detection time and extraction time of the sentinel lymph nodes were measured. The safety of the tracer mixture in terms of mucosal reaction was evaluated macroscopically and microscopically.
Sentinel lymph nodes were detected transcutaneously by contrast-enhanced ultrasonography alone. The number of sentinel lymph nodes detected was one or two. Despite observation of contrast enhancement of Sonazoid for at least 90 minutes, the number of sentinel lymph nodes detected did not change. The average extraction time of sentinel lymph nodes was 4.8 minutes. Indocyanine green fluorescence offered visual information during lymph node biopsy. The safety of the tracer was confirmed by absence of laryngeal edema both macro and microscopically.
The combination method of indocyanine green fluorescence and contrast-enhanced ultrasonography for detecting sentinel lymph nodes during surgery for head and neck cancer seems promising, especially for pharyngeal and laryngeal cancer. Further clinical studies to confirm this are warranted.
前哨淋巴结导航手术在口腔癌中越来越受欢迎。我们通过在动物模型中评估超声造影和吲哚菁绿荧光的联合应用，来评估前哨淋巴结导航手术在咽喉癌中的应用。
这是一项在兔和猪动物模型中进行的前瞻性、非随机实验研究。将吲哚菁绿和Sonazoid的混合物用作示踪剂。将示踪剂混合物注入舌、喉或咽。通过红外摄像机和超声造影经皮识别前哨淋巴结。测量前哨淋巴结的检测时间和提取时间。从宏观和微观角度评估示踪剂混合物在黏膜反应方面的安全性。
仅通过超声造影即可经皮检测到前哨淋巴结。检测到的前哨淋巴结数量为一或两个。尽管观察到Sonazoid的造影增强至少持续90分钟，但检测到的前哨淋巴结数量并未改变。前哨淋巴结的平均提取时间为4.8分钟。吲哚菁绿荧光在淋巴结活检过程中提供了视觉信息。通过宏观和微观检查均未发现喉水肿，证实了示踪剂的安全性。
吲哚菁绿荧光和超声造影联合用于头颈癌手术中检测前哨淋巴结的方法似乎很有前景，尤其是对于咽喉癌。有必要进行进一步的临床研究来证实这一点。
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