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Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer.

Mieog JS, Troyan SL, Hutteman M, Donohoe KJ, van der Vorst JR, Stockdale A, Liefers GJ, Choi HS, Gibbs-Strauss SL, Putter H, Gioux S, Kuppen PJ, Ashitate Y, Löwik CW, Smit VT, Oketokoun R, Ngo LH, van de Velde CJ, Frangioni JV, Vahrmeijer AL - Ann. Surg. Oncol. (2011)

Bottom Line: Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN.Optimal injection dose of ICG:HSA ranged between 400 and 800 μM.No adverse reactions were observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

ABSTRACT

Background: Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers.

Materials and methods: A small, portable version of the FLARE imaging system, termed Mini-FLARE, was developed for capturing color video and two semi-independent channels of NIR fluorescence (700 and 800 nm) in real time. Initial optimization of lymphatic tracer dose was performed using 35-kg Yorkshire pigs and a 6-patient pilot clinical trial. More refined optimization was performed in 24 consecutive breast cancer patients. All patients received the standard of care using (99m)Technetium-nanocolloid and patent blue. In addition, 1.6 ml of indocyanine green adsorbed to human serum albumin (ICG:HSA) was injected directly after patent blue at the same location. Patients were allocated to 1 of 8 escalating ICG:HSA concentration groups from 50 to 1000 μM.

Results: The Mini-FLARE system was positioned easily in the operating room and could be used up to 13 in. from the patient. Mini-FLARE enabled visualization of lymphatic channels and SLNs in all patients. A total of 35 SLNs (mean = 1.45, range 1-3) were detected: 35 radioactive (100%), 30 blue (86%), and 35 NIR fluorescent (100%). Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN. Optimal injection dose of ICG:HSA ranged between 400 and 800 μM. No adverse reactions were observed.

Conclusions: We describe the clinical translation of a new NIR fluorescence imaging system and define the optimal ICG:HSA dose range for SLN mapping in breast cancer.

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Related in: MedlinePlus

The Mini-FLARE portable near-infrared fluorescence imaging system. a Imaging system, composed of electronics/monitor cart and counterweighted imaging system pole. b Sterile drape/shield attached to the imaging head with other major parts identified. c Excitation and emission light paths, and filtration for the Mini-FLARE imaging system. DM, 650 nm dichroic mirror
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Fig1: The Mini-FLARE portable near-infrared fluorescence imaging system. a Imaging system, composed of electronics/monitor cart and counterweighted imaging system pole. b Sterile drape/shield attached to the imaging head with other major parts identified. c Excitation and emission light paths, and filtration for the Mini-FLARE imaging system. DM, 650 nm dichroic mirror

Mentions: The Mini-FLARE imaging system (Fig. 1a) is composed of a small portable electronics cart and a counterweighted pole stand that supports the imaging head. Unlike FLARE, Mini-FLARE uses a flexible gooseneck arm, which permits positioning of the imaging head at extreme angles virtually anywhere over the surgical field. The only consumable for Mini-FLARE is a specially designed acrylic splash plate that is hermetically sealed to a plastic drape. Using sterile technique, the shield/drape is inserted into the imaging head, locked into place, and the drape is unfolded to encase the imaging head and imaging system pole stand (Fig. 1b). Optical light paths for white light (i.e., color video images) and the 2 semi-independent NIR fluorescence channels, 1 centered at 700 nm emission and the other at 800 nm emission, are shown in Fig. 1c.Fig. 1


Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer.

Mieog JS, Troyan SL, Hutteman M, Donohoe KJ, van der Vorst JR, Stockdale A, Liefers GJ, Choi HS, Gibbs-Strauss SL, Putter H, Gioux S, Kuppen PJ, Ashitate Y, Löwik CW, Smit VT, Oketokoun R, Ngo LH, van de Velde CJ, Frangioni JV, Vahrmeijer AL - Ann. Surg. Oncol. (2011)

The Mini-FLARE portable near-infrared fluorescence imaging system. a Imaging system, composed of electronics/monitor cart and counterweighted imaging system pole. b Sterile drape/shield attached to the imaging head with other major parts identified. c Excitation and emission light paths, and filtration for the Mini-FLARE imaging system. DM, 650 nm dichroic mirror
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139732&req=5

Fig1: The Mini-FLARE portable near-infrared fluorescence imaging system. a Imaging system, composed of electronics/monitor cart and counterweighted imaging system pole. b Sterile drape/shield attached to the imaging head with other major parts identified. c Excitation and emission light paths, and filtration for the Mini-FLARE imaging system. DM, 650 nm dichroic mirror
Mentions: The Mini-FLARE imaging system (Fig. 1a) is composed of a small portable electronics cart and a counterweighted pole stand that supports the imaging head. Unlike FLARE, Mini-FLARE uses a flexible gooseneck arm, which permits positioning of the imaging head at extreme angles virtually anywhere over the surgical field. The only consumable for Mini-FLARE is a specially designed acrylic splash plate that is hermetically sealed to a plastic drape. Using sterile technique, the shield/drape is inserted into the imaging head, locked into place, and the drape is unfolded to encase the imaging head and imaging system pole stand (Fig. 1b). Optical light paths for white light (i.e., color video images) and the 2 semi-independent NIR fluorescence channels, 1 centered at 700 nm emission and the other at 800 nm emission, are shown in Fig. 1c.Fig. 1

Bottom Line: Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN.Optimal injection dose of ICG:HSA ranged between 400 and 800 μM.No adverse reactions were observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

ABSTRACT

Background: Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers.

Materials and methods: A small, portable version of the FLARE imaging system, termed Mini-FLARE, was developed for capturing color video and two semi-independent channels of NIR fluorescence (700 and 800 nm) in real time. Initial optimization of lymphatic tracer dose was performed using 35-kg Yorkshire pigs and a 6-patient pilot clinical trial. More refined optimization was performed in 24 consecutive breast cancer patients. All patients received the standard of care using (99m)Technetium-nanocolloid and patent blue. In addition, 1.6 ml of indocyanine green adsorbed to human serum albumin (ICG:HSA) was injected directly after patent blue at the same location. Patients were allocated to 1 of 8 escalating ICG:HSA concentration groups from 50 to 1000 μM.

Results: The Mini-FLARE system was positioned easily in the operating room and could be used up to 13 in. from the patient. Mini-FLARE enabled visualization of lymphatic channels and SLNs in all patients. A total of 35 SLNs (mean = 1.45, range 1-3) were detected: 35 radioactive (100%), 30 blue (86%), and 35 NIR fluorescent (100%). Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN. Optimal injection dose of ICG:HSA ranged between 400 and 800 μM. No adverse reactions were observed.

Conclusions: We describe the clinical translation of a new NIR fluorescence imaging system and define the optimal ICG:HSA dose range for SLN mapping in breast cancer.

Show MeSH
Related in: MedlinePlus