Department of Gynecology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
Gynecol Oncol. 2017 Sep;146(3):676-677. doi: 10.1016/j.ygyno.2017.06.009. Epub 2017 Jun 17.
Sentinel lymph node mapping, alone or in combination with pelvic lymphadenectomy, is considered a standard approach in staging of patients with cervical or endometrial cancer [1-3]. The goal of this video is to demonstrate the use of indocyanine green (ICG) and color-segmented fluorescence when performing lymphatic mapping in patients with gynecologic malignancies.
Injection of ICG is performed in two cervical sites using 1mL (0.5mL superficial and deep, respectively) at the 3 and 9 o'clock position. Sentinel lymph nodes are identified intraoperatively using the Pinpoint near-infrared imaging system (Novadaq, Ontario, CA). Color-segmented fluorescence is used to image different levels of ICG uptake demonstrating higher levels of perfusion. A color key on the side of the monitor shows the colors that coordinate with different levels of ICG uptake. Color-segmented fluorescence may help surgeons identify true sentinel nodes from fatty tissue that, although absorbing fluorescent dye, does not contain true nodal tissue. It is not intended to differentiate the primary sentinel node from secondary sentinel nodes. The key ranges from low levels of ICG uptake (gray) to the highest rate of ICG uptake (red).
Bilateral sentinel lymph nodes are identified along the external iliac vessels using both standard and color-segmented fluorescence. No evidence of disease was noted after ultra-staging was performed in each of the sentinel nodes.
Use of ICG in sentinel lymph node mapping allows for high bilateral detection rates. Color-segmented fluorescence may increase accuracy of sentinel lymph node identification over standard fluorescent imaging. The following are the supplementary data related to this article.
前哨淋巴结绘图，单独或结合盆腔淋巴结切除术，被认为是宫颈癌或子宫内膜癌分期的标准方法[1-3]。本视频的目的是演示在妇科恶性肿瘤患者中进行淋巴绘图时使用吲哚菁绿（ICG）和彩色分段荧光。
在宫颈的 3 点和 9 点位置分别用 1mL（分别为 0.5mL 浅层和深层）注射 ICG。使用 Pinpoint 近红外成像系统（Novadaq，安大略省，加拿大）在术中识别前哨淋巴结。使用彩色分段荧光成像来显示不同水平的 ICG 摄取，以显示更高的灌注水平。监视器侧面的颜色键显示与不同水平的 ICG 摄取相对应的颜色。彩色分段荧光可以帮助外科医生从吸收荧光染料但不包含真正的淋巴结组织的脂肪组织中识别真正的前哨淋巴结。它不是为了区分原发性前哨淋巴结和继发性前哨淋巴结。关键范围从 ICG 摄取的低水平（灰色）到 ICG 摄取的最高水平（红色）。
使用标准荧光和彩色分段荧光在外髂血管上识别双侧前哨淋巴结。在对每个前哨淋巴结进行超分期后，均未发现疾病证据。
在使用 ICG 进行前哨淋巴结绘图时，可以实现高双侧检测率。与标准荧光成像相比，彩色分段荧光可能会提高前哨淋巴结识别的准确性。
