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. 2011 Oct;13(5):1043-9.
doi: 10.1007/s11307-010-0425-7.

Intraoperative multispectral fluorescence imaging for the detection of the sentinel lymph node in cervical cancer: a novel concept

Lucia M A Crane  1 , George Themelis, Rick G Pleijhuis, Niels J Harlaar, Athanasios Sarantopoulos, Henriette J G Arts, Ate G J van der Zee, Vasilis Ntziachristos, Gooitzen M van Dam
Affiliations

Intraoperative multispectral fluorescence imaging for the detection of the sentinel lymph node in cervical cancer: a novel concept

Lucia M A Crane et al. Mol Imaging Biol. 2011 Oct.

Erratum in

  • Mol Imaging Biol. 2011 Oct;13(5):1050. Vasilis, Ntziachristos [corrected to Ntziachristos, Vasilis]

Abstract

Purpose: Real-time intraoperative near-infrared fluorescence (NIRF) imaging is a promising technique for lymphatic mapping and sentinel lymph node (SLN) detection. The purpose of this technical feasibility pilot study was to evaluate the applicability of NIRF imaging with indocyanin green (ICG) for the detection of the SLN in cervical cancer.

Procedures: In ten patients with early stage cervical cancer, a mixture of patent blue and ICG was injected into the cervix uteri during surgery. Real-time color and fluorescence videos and images were acquired using a custom-made multispectral fluorescence camera system.

Results: Real-time fluorescence lymphatic mapping was observed in vivo in six patients; a total of nine SLNs were detected, of which one (11%) contained metastases. Ex vivo fluorescence imaging revealed the remaining fluorescent signal in 11 of 197 non-sentinel LNs (5%), of which one contained metastatic tumor tissue. None of the non-fluorescent LNs contained metastases.

Conclusions: We conclude that lymphatic mapping and detection of the SLN in cervical cancer using intraoperative NIRF imaging is technically feasible. However, the technique needs to be refined for full applicability in cervical cancer in terms of sensitivity and specificity.

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Conflict of interest statement

Dr. G.M. van Dam and V. Ntziachristos are members of the Scientific Advisory Board of SurgOptix Inc. All other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Lymph drainage of the cervix uteri is complex, bilateral, and can affect lymph nodes in several areas. In our pilot study, nine SLNs were found. These were localized in the left obturator fossa (three), right obturator fossa (two), left external iliac (one), right external iliac (one), right common iliac (one), and on the junction of the right internal iliac and obturator fossa (one).
Fig. 2
Fig. 2
Camera system wrapped in sterile drapes in the operating theater.
Fig. 3
Fig. 3
In vivo fluorescence imaging of a lymph node. a Color image. b Fluorescence image. c Overlay of the pseudocolor fluorescent signal on top of the color image.
Fig. 4
Fig. 4
Ex vivo fluorescence imaging of a cluster of lymph nodes. a Color image. b Fluorescence image. c Overlay of the pseudocolor fluorescent signal on top of the color image. This fluorescent lymph node did not contain metastases.
See this image and copyright information in PMC

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