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Wollbrett C, Seitlinger J, Stasiak F, Piccoli J, Streit A, Siat J, Gauchotte G, Renaud S. Clinicopathological factors associated with sentinel lymph node detection in non-small-cell lung cancer. J Cardiothorac Surg 2024; 19:145. [PMID: 38504315 PMCID: PMC10949663 DOI: 10.1186/s13019-024-02632-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Mapping of the pulmonary lymphatic system by near-infrared (NIR) fluorescence imaging might not always identify the first lymph node relay. The aim of this study was to determine the clinicopathologic factors allowing the identification of sentinel lymph nodes (SLNs) by NIR fluorescence imaging in thoracic surgery for non-small-cell lung cancer (NSCLC). METHODS We conducted a retrospective review of 92 patients treated for suspected or confirmed cN0 lung cancer with curative intent who underwent an intraoperative injection of indocyanine green (ICG) either by direct peritumoral injection or by endobronchial injection using electromagnetic navigational bronchoscopy (ENB). After exclusion of patients for technical failure, benign disease and metastasis, we analyzed the clinicopathologic findings of 65 patients treated for localized-stage NSCLC, comparing the group with identification of SLNs (SLN-positive group) with the group without identification of SLNs (SLN-negative group). RESULTS Forty-eight patients (73.8%) were SLN-positive. Patients with SLN positivity were more frequently female (50%) than the SLN-negative patients were (11.8%) (p = 0.006). The mean value of diffusing capacity for carbon monoxide (DLCO) was lower among the patients in the SLN-negative group (64.7% ± 16.7%) than the SLN-positive group (77.6% ± 17.2%, p < 0.01). The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FCV) was higher in the SLN-positive group (69.0% vs. 60.8%, p = 0.02). Patients who were SLN-negative were characterized by a severe degree of emphysema (p = 0.003). There was no significant difference in pathologic characteristics. On univariate analyses, age, female sex, DLCO, FEV1/FVC, degree of emphysema, and tumor size were significantly associated with SLN detection. On multivariate analysis, DLCO > 75% (HR = 4.92, 95% CI: 1.27-24.7; p = 0.03) and female sex (HR = 5.55, 95% CI: 1.25-39.33; p = 0.04) were independently associated with SLN detection. CONCLUSIONS At a time of resurgence in the use of the sentinel lymph node mapping technique in the field of thoracic surgery, this study enabled us to identify, using multivariate analysis, two predictive factors for success: DLCO > 75% and female sex. Larger datasets are needed to confirm our results.
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Affiliation(s)
- Christophe Wollbrett
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Florent Stasiak
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Juliette Piccoli
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Arthur Streit
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Guillaume Gauchotte
- Department of Pathology and Molecular Biology, Nancy Regional University Hospital, Vandoeuvre-lès-Nancy, 54500, France
- Research Unit INSERM U1256, NGERE Unit, Lorraine University, Vandoeuvre-lès-Nancy, 54500, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France.
- Research Unit INSERM U1256, NGERE Unit, Lorraine University, Vandoeuvre-lès-Nancy, 54500, France.
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Caimano M, Bianco G, Coppola A, Marrone G, Agnes S, Lai Q, Spoletini G. Indocyanine green clearance tests to assess liver transplantation outcomes: a systematic review. Int J Surg 2024; 110:431-440. [PMID: 37800567 PMCID: PMC10793811 DOI: 10.1097/js9.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/09/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Liver transplantation (LT) is the gold standard for end-stage liver disease, yet postoperative complications challenge patients and physicians. Indocyanine green (ICG) clearance, a quantitative dynamic test of liver function, is a rapid, reproducible, and reliable test of liver function. This study aimed to systematically review and summarize current literature analyzing the association between ICG tests and post-LT outcomes. METHODS This systematic review was conducted according to PRISMA guidelines. MEDLINE and Cochrane Library, as main databases, and other sources were searched until August 2022 to identify articles reporting the prognostic value of postoperative ICG tests associated with outcomes of adult LT recipients.Risk of bias of included articles was assessed using Quality In Prognosis Studies tool. Methodological quality varied from low to high across risk of bias domains. RESULTS Six studies conducted between 1994 and 2018 in Europe, America, and Asia were included. The study population ranged from 50 to 332 participants. ICG clearance on the first postoperative day was associated with early allograft dysfunction, graft loss, 1-month and 3-month patient survival probability, prolonged ICU, and hospital stay. The dichotomized ICG plasma disappearance rate (PDR) provided a strong association with medium-term and long-term outcomes: PDR less than 10%/min with 1-month mortality or re-transplantation (odds ratio: 7.89, 95% CI 3.59-17.34, P <0.001) and PDR less than 16.0%/min with 3-month patient survival probability (hazard ratio: 13.90, 95% CI 4.67-41.35, P <0.01). The preoperative model for end-stage liver disease and body mass index were independent prognostic factors for early allograft dysfunction, early complications, and prolonged ICU stay; post-LT prothrombin time and INR were independently associated with graft loss and bilirubin with a prolonged hospital stay. CONCLUSION This review shows that ICG clearance tests are associated with graft function recovery, suggesting that a potential prognostic role of ICG test, as an aid in predicting the post-LT course, could be considered.
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Affiliation(s)
- Miriam Caimano
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Giuseppe Bianco
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Alessandro Coppola
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | | | - Salvatore Agnes
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Quirino Lai
- Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Li Z, Xia M, Liu C, Xie L, Wang T, Ren Y. A novel, simple near-infrared thoracoscopic technique by a particular route for locating lung nodules. Front Oncol 2023; 13:1278563. [PMID: 37886171 PMCID: PMC10598650 DOI: 10.3389/fonc.2023.1278563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Background The localization of pulmonary nodules prior to thoracoscopic surgery remains challenging for thoracic surgeons, especially for those nodules that are not visible or palpable on the lung surface. Our study is a simple and effective minimally invasive method using indocyanine green through a special pathway to locate pulmonary nodules and fluorescence thoracoscopic surgery. Methods Thoracoscopic surgery was performed for 18 undiagnosed peripheral non-solid nodules no larger than 2 cm after location. After 0.3 mg/kg indocyanine green was injected through the peripheral vein, the puncture needle was pulled out after it reached approximately 1 cm of the pulmonary parenchyma near the nodules. This was followed by transfer to the operating room. The nodule was initially localized by using a near-infrared thoracoscope to visualize indocyanine green fluorescence. Then, thoracoscopic resection was performed. Results Eighteen patients received this special and simple localization method, and underwent near-infrared, image-guided, video-assisted thoracoscopic surgery resection. Median computed tomography (CT) tumor size was 1.2 cm. Median depth from the pleural surface is 1.6 cm (range, 0.1-4.6 cm). The median time of CT-guided intervention was 12 min. The duration of thoracoscopic surgery was 67 min. Indocyanine green fluorescence was clearly identified in 17 of 18 patients (94.4%). The surgical margins were all negative on final pathology. The final diagnoses included 17 primary lung cancers, and 1 benign lung tumor. Conclusions CT-guided single puncture of indocyanine green after peripheral intravenous injection is a simple, effective, and safe method to locate the nodule. This offers surgeons the ease of localization through direct indocyanine green fluorescence imaging, and it can be used as an effective alternative to other placement methods of locating pulmonary nodules.
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Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Mozhu Xia
- Department of Operation Room, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Chang Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Liwei Xie
- Department of Radiology, Shenyang Chest Hospital, Shenyang, China
| | - Tao Wang
- Department of Anesthesia, Shenyang Chest Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
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Llaguno-Munive M, Villalba-Abascal W, Avilés-Salas A, Garcia-Lopez P. Near-Infrared Fluorescence Imaging in Preclinical Models of Glioblastoma. J Imaging 2023; 9:212. [PMID: 37888319 PMCID: PMC10607214 DOI: 10.3390/jimaging9100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
Cancer is a public health problem requiring ongoing research to improve current treatments and discover novel therapies. More accurate imaging would facilitate such research. Near-infrared fluorescence has been developed as a non-invasive imaging technique capable of visualizing and measuring biological processes at the molecular level in living subjects. In this work, we evaluate the tumor activity in two preclinical glioblastoma models by using fluorochrome (IRDye 800CW) coupled to different molecules: tripeptide Arg-Gly-Asp (RGD), 2-amino-2-deoxy-D-glucose (2-DG), and polyethylene glycol (PEG). These molecules interact with pathological conditions of tumors, including their overexpression of αvβ3 integrins (RGD), elevated glucose uptake (2-DG), and enhanced permeability and retention effect (PEG). IRDye 800CW RGD gave the best in vivo fluorescence signal from the tumor area, which contrasted well with the low fluorescence intensity of healthy tissue. In the ex vivo imaging (dissected tumor), the accumulation of IRDye 800CW RGD could be appreciated at the tumor site. Glioblastoma tumors were presently detected with specificity and sensitivity by utilizing IRDye 800CW RGD, a near-infrared fluorophore combined with a marker of αvβ3 integrin expression. Further research is needed on its capacity to monitor tumor growth in glioblastoma after chemotherapy.
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Affiliation(s)
- Monserrat Llaguno-Munive
- Laboratorio de Fármaco-Oncología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (M.L.-M.); (W.V.-A.)
- Laboratorio de Física Médica, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Wilberto Villalba-Abascal
- Laboratorio de Fármaco-Oncología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (M.L.-M.); (W.V.-A.)
| | - Alejandro Avilés-Salas
- Departamento de Patología, Instituto Nacional de Cancerología, Mexico City 14080, Mexico;
| | - Patricia Garcia-Lopez
- Laboratorio de Fármaco-Oncología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (M.L.-M.); (W.V.-A.)
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Niu S, Liu Y, Li D, Sheng Y, Zhang Y, Li Z, Zhao S, Wang T. Effect of indocyanine green near-infrared light imaging technique guided lymph node dissection on short-term clinical efficacy of minimally invasive radical gastric cancer surgery: a meta-analysis. Front Oncol 2023; 13:1257585. [PMID: 37766867 PMCID: PMC10520705 DOI: 10.3389/fonc.2023.1257585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Objective In recent years, the utilization of indocyanine green near-infrared (ICG NIR) light imaging-guided lymph node dissection in the context of minimally invasive radical gastric cancer has emerged as a novel avenue for investigation. The objective of this study was to assess the influence of employing this technique for guiding lymph node dissection on the short-term clinical outcomes of minimally invasive radical gastric cancer surgery. Methods The present study conducted a comprehensive search for short-term clinical outcomes, comparing the group undergoing ICG NIR light imaging-guided lymph node dissection with the control group, by thoroughly examining relevant literature from the inception to July 2023 in renowned databases such as PubMed, Embase, Web of Science, and Cochrane Library. The primary endpoints encompassed postoperative complications, including abdominal infection, abdominal bleeding, pneumonia, anastomotic fistula, and overall incidence of complications (defined as any morbidity categorized as Clavien-Dindo class I or higher within 30 days post-surgery or during hospitalization). Additionally, secondary outcome measures consisted of the time interval until the initiation of postoperative gas and food intake, as well as various other parameters, namely postoperative hospital stay, operative time, intraoperative blood loss, total number of harvested lymph nodes, and the number of harvested metastatic lymph nodes. To ensure methodological rigor, the Cochrane Collaboration Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) were employed to assess the quality of the included studies, while statistical analyses were performed using Review Manager 5.4 software and Stata, version 12.0 software. Results A total of 19 studies including 3103 patients were ultimately included (n=1276 in the ICG group and n=1827 in the non-ICG group). In this meta-analysis, the application of ICG near-infrared light imaging in minimally invasive radical gastric cancer surgery effectively improved the occurrence of postoperative Clavien-Dindo grade II or higher complications in patients (RR=0.72, 95% CI 0.52 to 1.00) with a statistically significant P=0.05; in reducing intraoperative blood loss and shortening While reducing intraoperative blood loss and shortening postoperative hospital stay, it could ensure the thoroughness of lymph node dissection in minimally invasive radical gastric cancer surgery (MD=5.575, 95% CI 3.677-7.473) with significant effect size (Z=5.76, p<0.00001). Conclusion The utilization of indocyanine green near-infrared light imaging technology in the context of minimally invasive radical gastric cancer surgery demonstrates notable efficacy in mitigating the occurrence of postoperative complications surpassing Clavien-Dindo grade II, while concurrently augmenting both the overall quantity of lymph node dissections and the identification of positive lymph nodes, all the while ensuring the preservation of surgical safety. Furthermore, the implementation of this technique proves particularly advantageous in the realm of robotic-assisted radical gastric cancer surgery, thus bearing significance for enhancing the short-term prognostic outcomes of patients.
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Affiliation(s)
- Sen Niu
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Yuan Liu
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Da Li
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Yufan Sheng
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Ye Zhang
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Zengyao Li
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Songyun Zhao
- Department of Neurosurgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
| | - Tong Wang
- Department of General Surgery, Wuxi People’s Hospital Affiliated To Nanjing Medical University, Wuxi, China
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Qiu Y, Yuan B, Cao Y, He X, Akakuru OU, Lu L, Chen N, Xu M, Wu A, Li J. Recent progress on near-infrared fluorescence heptamethine cyanine dye-based molecules and nanoparticles for tumor imaging and treatment. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1910. [PMID: 37305979 DOI: 10.1002/wnan.1910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
Recenly, near-infrared fluorescence heptamethine cyanine dyes have shown satisfactory values in bioengineering, biology, and pharmacy especially in cancer diagnosis and treatment, owing to their excellent fluorescence property and biocompatibility. In order to achieve broad application prospects, diverse structures, and chemical properties of heptamethine cyanine dyes have been designed to develop novel functional molecules and nanoparticles over the past decade. For fluorescence and photoacoustic tumor imaging properties, heptamethine cyanine dyes are equipped with good photothermal performance and reactive oxygen species production properties under near-infrared light irradiation, thus holding great promise in photodynamic and/or photothermal cancer therapies. This review offers a comprehensive scope of the structures, comparisons, and applications of heptamethine cyanine dyes-based molecules as well as nanoparticles in tumor treatment and imaging in current years. Therefore, this review may drive the development and innovation of heptamethine cyanine dyes, significantly offering opportunities for improving tumor imaging and treatment in a precise noninvasive manner. This article is categorized under: Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Yue Qiu
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Bo Yuan
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Yi Cao
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xuelu He
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Ozioma Udochukwu Akakuru
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Liheng Lu
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Nengwen Chen
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Mengting Xu
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Aiguo Wu
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Advanced Energy Science and Technology Guangdong Laboratory, Huizhou, Guangdong, China
| | - Juan Li
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Zhejiang International Cooperation Base of Biomedical Materials Technology and Application, Chinese Academy of Sciences (CAS) Key Laboratory of Magnetic Materials and Devices, Ningbo Cixi Institute of Biomedical Engineering, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Advanced Energy Science and Technology Guangdong Laboratory, Huizhou, Guangdong, China
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Ng CSH, Ong BH, Chao YK, Wright GM, Sekine Y, Wong I, Hao Z, Zhang G, Chaturvedi H, Thammineedi SR, Law S, Kim HK. Use of Indocyanine Green Fluorescence Imaging in Thoracic and Esophageal Surgery. Ann Thorac Surg 2023; 115:1068-1076. [PMID: 36030832 DOI: 10.1016/j.athoracsur.2022.06.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Fluorescence imaging using indocyanine green in thoracic and esophageal surgery is gaining popularity because of the potential to facilitate surgical planning, to stage disease, and to reduce postoperative complications. To optimize use of fluorescence imaging in thoracic and esophageal surgery, an expert panel sought to establish a set of recommendations at a consensus meeting. METHODS The panel included 12 experts in thoracic and upper gastrointestinal surgery from Asia-Pacific countries. Before meeting, 7 focus areas were defined: intersegmental plane identification for sublobar resections; pulmonary nodule localization; lung tumor detection; bullous lesion detection; lymphatic mapping of lung tumors; evaluation of gastric conduit perfusion; and lymphatic mapping in esophageal surgical procedures. A literature search of the PubMed database was conducted using keywords indocyanine green, fluorescence, thoracic, surgery, and esophagectomy. At the meeting, panelists addressed each focus area by discussing the most relevant evidence and their clinical experiences. Consensus statements were derived from the proceedings, followed by further discussions, revisions, finalization, and unanimous agreement. Each statement was assigned a level of evidence and a grade of recommendation. RESULTS A total of 9 consensus recommendations were established. Identification of the intersegmental plane for sublobar resections, localization of pulmonary nodules, lymphatic mapping in lung tumors, and assessment of gastric conduit perfusion were applications of fluorescence imaging that have the most robust current evidence. CONCLUSIONS Based on best available evidence and expert opinions, these consensus recommendations may facilitate thoracic and esophageal surgery using fluorescence imaging.
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Affiliation(s)
- Calvin Sze-Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yin Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
| | - Gavin M Wright
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Yasuo Sekine
- Department of Thoracic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Japan
| | - Ian Wong
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Zhexue Hao
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | | | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Korea
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Ter Woerds DKM, Verhoeven RLJ, van der Heide SM, Verhagen AFTM, Aarntzen EHJG, van der Heijden EHFM. Ex-vivo exploration of an endobronchial sentinel lymph node procedure in lung cancer for optimizing workflow and evaluating feasibility of novel imaging tools. J Thorac Dis 2023; 15:291-299. [PMID: 36910083 PMCID: PMC9992569 DOI: 10.21037/jtd-22-984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 02/15/2023]
Abstract
Background Early-stage lung cancer is treated with curative intent by surgery or radiotherapy. However, upstaging is frequently seen after surgery in clinical N0 lung cancer patients, and despite curative intent, 2-year recurrence rates of 9-28% are reported. A sentinel lymph node (SLN) procedure could improve the staging accuracy. We explored the feasibility of performing a navigation bronchoscopy based SLN procedure in human ex-vivo lung cancer specimens to optimize procedural parameters and assess a novel injection tool. Methods Ten lung resection specimens were included and allocated to either peri- or intratumoral injection of a tracer combining 99mTc-nanocolloid and indocyanine green (ICG) while varying the injection volume. A Pioneer Plus catheter with a pre-angulated 24G needle and an ultrasound (US)-element was used to perform real-time US guided transbronchial injections at multiple locations. Thereafter, single photon emission computed tomography/computed tomography (SPECT/CT)-scanning was performed to image injection depots and to assess their location relative to the tumor. Results An average volume of 0.7 mL (range, 0.3-1.2 mL) with an average activity of 89.5 MBq 99mTc (range, 35.4-188.0 MBq) was injected. Intratumoral injections in non-solid and solid tumors were successful in 100% and 64.3% respectively, while 100% of peritumoral injections in solid tumors were successful. The US-element of the catheter allowed real-time imaging and was able to visualize all tumors and 67.4% of all injections. SPECT/CT-scanning visualized 76.7% of the injection depots. Conclusions A navigation bronchoscopy mediated SLN procedure seems technically feasible. The Pioneer Plus is a suitable catheter to place tracer depots at multiple intra-/peri-tumoral sites, while receiving real-time feedback on the needle localization in relation to the tumor. The next step of in-vivo injections will determine if tracer drainage to the SLN can also be detected on pre- and per-operative imaging.
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Affiliation(s)
- Desi K M Ter Woerds
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel L J Verhoeven
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan M van der Heide
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad F T M Verhagen
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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Chen S, Tian X, Ju G, Shi M, Chen Y, Wang Q, Dai W, Li T, Pan J, Fan Y. Indocyanine green near-infrared imaging-guided lymph node dissection during oesophageal cancer surgery: A single-centre experience. Front Surg 2023; 9:982306. [PMID: 36700018 PMCID: PMC9869681 DOI: 10.3389/fsurg.2022.982306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Objective This study aimed to investigate the feasibility of using indocyanine green (ICG) near-infrared (NIR) imaging during lymphadenectomy for oesophageal cancer. Methods Eighty-seven patients with primary oesophageal cancer were enrolled in this study. All the enrolled patients received an endoscopic injection of ICG between 40 min and 23 h before surgery. Nodal dissection during surgery was performed under fluorescence imaging visualisation, with the NIR signal shown in purple. ICG+ or ICG- nodes were recorded station by station and were microscopically evaluated. Results Endoscopic peritumoral ICG injection was successfully performed in all patients. Major post-surgery complications included wound infection, pleural effusion, dysphonia, pneumonia and anastomotic fistula. No patients experienced ICG-related adverse events. A total of 2,584 lymph nodes were removed, and the mean number of lymph nodes for each patient was 29.70 ± 9.24. Most of the removed nodes (97.83%) were ICG+, and 3.32% of the ICG+ nodes were metastatic. No metastatic nodes were ICG- or belonged to an ICG- lymph node station. The time from ICG injection to surgery did not affect the number of harvested lymph nodes. Conclusions The use of ICG-NIR imaging during oesophageal cancer surgery can enhance the visualisation of lymph nodes during surgery. It is a feasible, safe and helpful technique for lymphadenectomy.
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Affiliation(s)
- Saihua Chen
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Xiaofeng Tian
- Department of Endoscopy Center, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Guanjun Ju
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Minxin Shi
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Yibiao Chen
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Qing Wang
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Wencheng Dai
- Department of Head and Neck Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Tinghua Li
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Jing Pan
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Yihui Fan
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Nantong University, Nantong Tumor Hospital, Nantong, China,Correspondence: Yihui Fan
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10
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Novruzbekov MS, Lutsyk KN, Olisov OD, Magomedov KM, Kazymov BI, Alekberov KF, Akhmedov AR, Yaremin BI. [Indocyanine green in liver transplantation]. Khirurgiia (Mosk) 2023:63-72. [PMID: 37682549 DOI: 10.17116/hirurgia202309263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The purpose of this study was to evaluate the first own experience of using indocyanine green (ICG) in liver transplantation compared to literature data and to determine its potential for clinical practice. Liver transplantation is an effective option for patients with end-stage disease, but this procedure is associated with many problems such as graft rejection, graft dysfunction, surgical risk and postoperative management. Modern methods for assessing graft function have their limitations, so a more efficient method is needed. According to this review, ICG fluorescence is valuable for effective intraoperative blood flow control, assessment of graft function, intraoperative and postoperative monitoring of clinical status. ICG fluorescence can also predict clinical status of patients at all stages of liver transplantation. Routine ICG fluorescence method is advisable in liver transplantation to improve outcomes and optimize treatment process.
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Affiliation(s)
- M S Novruzbekov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K N Lutsyk
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - O D Olisov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K M Magomedov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - B I Kazymov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - K F Alekberov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A R Akhmedov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - B I Yaremin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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11
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Zhang X, Yu F, Wang Z, Jiang T, Song X, Yu F. Fluorescence probes for lung carcinoma diagnosis and clinical application. SENSORS & DIAGNOSTICS 2023; 2:1077-1096. [DOI: 10.1039/d3sd00029j] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
This review provides an overview of the most recent developments in fluorescence probe technology for the accurate detection and clinical therapy of lung carcinoma.
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Affiliation(s)
- Xiaoyu Zhang
- Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 571199, China
- Department of Pulmonary and Critical Care Medicine, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, China
| | - Feifei Yu
- Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 571199, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, Engineering Research Center for Hainan Bio-Smart Materials and Bio-Medical Devices, Key Laboratory of Hainan Functional Materials and Molecular Imaging, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, China
| | - Zhenkai Wang
- Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 571199, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, Engineering Research Center for Hainan Bio-Smart Materials and Bio-Medical Devices, Key Laboratory of Hainan Functional Materials and Molecular Imaging, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, China
| | - Tongmeng Jiang
- Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 571199, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, Engineering Research Center for Hainan Bio-Smart Materials and Bio-Medical Devices, Key Laboratory of Hainan Functional Materials and Molecular Imaging, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, China
| | - Xinyu Song
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medicine University, Guangzhou 510120, China
| | - Fabiao Yu
- Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou 571199, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, Engineering Research Center for Hainan Bio-Smart Materials and Bio-Medical Devices, Key Laboratory of Hainan Functional Materials and Molecular Imaging, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, China
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12
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Singhal S, Azari F, Caponetti GC, Kennedy GT. Novel intraoperative near-infrared imaging strategy to identify abnormalities in the anterior mediastinum. J Cardiothorac Surg 2022; 17:302. [PMID: 36494869 PMCID: PMC9734605 DOI: 10.1186/s13019-022-02054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Thoracic surgeons are frequently asked to biopsy suspicious tissues in the anterior mediastinum to discriminate between a reactive versus malignant pathology such as lymph nodes. The most common benign cause of a mediastinal lymph node is a reactive lymph node from a prior infection or inflammatory process such as post-COVID or granulomatous disease. The most common malignant cause is a lymphoproliferative disorder but also metastatic disease from neck, breast and other regional cancers. Biopsies in this location are challenging because they are far from the trachea and the sternum is a barrier to most diagnostic procedures. Thus, a surgical biopsy is frequently required and a common procedure for Thoracic surgeons. Technically, identifying these lesions can be challenging, particularly for small lesions or those in patients with high body mass index. In order to improve contrast between diseased tissue in the anterior mediastinum and surrounding adipose tissue, we have been studying near-infrared imaging during surgery using indocyanine green (ICG) to give contrast to the abnormal tissues and to avoid an unnecessary extended resection. We developed a modified technique to give ICG to a patient during a biopsy in the anterior mediastinum to specifically highlight abnormal tissues. As a proof-of-principle, we present a case of a young woman with a suspicious 2 cm mediastinal lymph node that required surgical biopsy.
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Affiliation(s)
- Sonia Singhal
- grid.25879.310000 0004 1936 8972Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA
| | - Feredun Azari
- grid.25879.310000 0004 1936 8972Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA
| | - Gabriel C. Caponetti
- grid.25879.310000 0004 1936 8972Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA
| | - Gregory T. Kennedy
- grid.25879.310000 0004 1936 8972Department of Surgery, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA USA ,grid.411115.10000 0004 0435 0884Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 USA
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13
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Krause K, Schumacher LY, Sachdeva UM. Advances in Imaging to Aid Segmentectomy for Lung Cancer. Surg Oncol Clin N Am 2022; 31:595-608. [DOI: 10.1016/j.soc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Neijenhuis LKA, de Myunck LDAN, Bijlstra OD, Kuppen PJK, Hilling DE, Borm FJ, Cohen D, Mieog JSD, Steup WH, Braun J, Burggraaf J, Vahrmeijer AL, Hutteman M. Near-Infrared Fluorescence Tumor-Targeted Imaging in Lung Cancer: A Systematic Review. Life (Basel) 2022; 12:life12030446. [PMID: 35330197 PMCID: PMC8950608 DOI: 10.3390/life12030446] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the most common cancer type worldwide, with non-small cell lung cancer (NSCLC) being the most common subtype. Non-disseminated NSCLC is mainly treated with surgical resection. The intraoperative detection of lung cancer can be challenging, since small and deeply located pulmonary nodules can be invisible under white light. Due to the increasing use of minimally invasive surgical techniques, tactile information is often reduced. Therefore, several intraoperative imaging techniques have been tested to localize pulmonary nodules, of which near-infrared (NIR) fluorescence is an emerging modality. In this systematic review, the available literature on fluorescence imaging of lung cancers is presented, which shows that NIR fluorescence-guided lung surgery has the potential to identify the tumor during surgery, detect additional lesions and prevent tumor-positive resection margins.
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Affiliation(s)
- Lisanne K. A. Neijenhuis
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands;
| | - Lysanne D. A. N. de Myunck
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
| | - Okker D. Bijlstra
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
| | - Peter J. K. Kuppen
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
| | - Denise E. Hilling
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
- Department of Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Frank J. Borm
- Department of Pulmonology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - J. Sven D. Mieog
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
| | - Willem H. Steup
- Department of Surgery, HAGA Hospital, 2545 AA The Hague, The Netherlands;
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | | | - Alexander L. Vahrmeijer
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
| | - Merlijn Hutteman
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.K.A.N.); (L.D.A.N.d.M.); (O.D.B.); (P.J.K.K.); (D.E.H.); (J.S.D.M.); (A.L.V.)
- Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
- Correspondence: ; Tel.: +31-71-526-51-00
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15
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Multifunctional Cyanine-Based Theranostic Probe for Cancer Imaging and Therapy. Int J Mol Sci 2021; 22:ijms222212214. [PMID: 34830094 PMCID: PMC8625430 DOI: 10.3390/ijms222212214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 02/06/2023] Open
Abstract
Cancer is one of the leading causes of death in the world. A cancer-targeted multifunctional probe labeled with the radionuclide has been developed to provide multi-modalities for NIR fluorescence and nuclear imaging (PET, SPECT), for photothermal therapy (PTT), and targeted radionuclide therapy of cancer. In this study, synthesis, characterization, in vitro, and in vivo biological evaluation of the cyanine-based probe (DOTA-NIR790) were demonstrated. The use of cyanine dyes for the selective accumulation of cancer cells were used to achieve the characteristics of tumor markers. Therefore, all kinds of organ tumors can be targeted for diagnosis and treatment. The DOTA-NIR790 labeled with lutetium-111 could detect original or metastatic tumors by using SPECT imaging and quantify tumor accumulation. The β-emission of 177Lu-DOTA-NIR790 can be used for targeted radionuclide therapy of tumors. The DOTA-NIR790 enabled imaging by NIR fluorescence and by nuclear imaging (SPECT) to monitor in real-time the tumor accumulation and the situation of cancer therapy, and to guide the surgery or the photothermal therapy of the tumor. The radionuclide-labeled heptamethine cyanine based probe (DOTA-NIR790) offers multifunctional modalities for imaging and therapies of cancer.
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Xia CW, Hu SQ, Zhou QZ, Gan RL, Pan JR, Zhang Q, Pu YM, Chen S, Hu QG, Wang YX. Accurately Locating Metastatic Foci in Lymph Nodes With Lugol's Iodine-Enhanced Micro-CT Imaging. Front Oncol 2021; 11:594915. [PMID: 34604023 PMCID: PMC8481801 DOI: 10.3389/fonc.2021.594915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Accurate evaluation of lymph node (LN) status is the key factor to determine the treatment and evaluate prognosis for patients with cancer. However, traditional pathological examination resulted in a 30% false-negative rate of detection of metastases in LNs. This study aimed to utilize Lugol's iodine (I2-IK)-enhanced micro-CT imaging to reveal the 3-dimensional structure of regional LNs and decrease the false-negative rate in pathological examination. Methods To explore the feasibility of I2-IK-enhanced micro-CT imaging in locating metastatic lesion in LNs, nonmetastatic and metastatic LNs from mice were used to mimic the imaging process. Then, the LNs from oral squamous cell carcinoma (OSCC) patients were applied to verify the value of I2-IK-enhanced micro-CT imaging in revealing LN structure and locating metastatic lesions in LNs. The glycogen content in nonmetastatic and metastatic LNs was further detected by the use of a glycogen assay kit and periodic acid-Schiff (PAS) staining to explain the imaging differences between them. Results In nude mice, 0.5% I2-IK staining for 4 h was the best parameter for normal LN. The metastatic foci in metastatic LNs were also clearly outlined in this condition. For nonmetastatic LNs from patients with OSCC, 1% I2-IK staining for 12 h was the best parameter. However, due to the increased volume of metastatic LNs, the image effect of 3% I2-IK staining for 12 h was superior to 1% I2-IK staining [tumor background ratio (TBR), 3% vs. 1%, 1.89 ± 0.10 vs. 1.27 ± 0.07, p < 0.001]. Compared with subsequent pathological sections, we found the CT intensity of metastatic foci in LNs and muscle tissues was significantly higher than in nonmetastatic regions. Meanwhile, the glycogen content of metastatic foci in LNs detected was also significantly higher than in nonmetastatic region. Conclusions I2-IK-enhanced micro-CT imaging could identify the spatial location of metastatic foci in LNs. This will be an effective method to assist in decreasing the LN false-negative rate for cancer pathology.
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Affiliation(s)
- Cheng-Wan Xia
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shi-Qi Hu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qun-Zhi Zhou
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong-Lin Gan
- Department of Stomatology, The Suzhou Hospital affiliated to the Nanjing Medical University, Suzhou, China
| | - Jiong-Ru Pan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qian Zhang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yu-Mei Pu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shen Chen
- Department of Oral Pathology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qin-Gang Hu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yu-Xin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Lee SH, Quan YH, Kim MS, Kwon KH, Choi BH, Kim HK, Kim BM. Design and Testing of Augmented Reality-Based Fluorescence Imaging Goggle for Intraoperative Imaging-Guided Surgery. Diagnostics (Basel) 2021; 11:diagnostics11060927. [PMID: 34064205 PMCID: PMC8224390 DOI: 10.3390/diagnostics11060927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
The different pathways between the position of a near-infrared camera and the user's eye limit the use of existing near-infrared fluorescence imaging systems for tumor margin assessments. By utilizing an optical system that precisely matches the near-infrared fluorescence image and the optical path of visible light, we developed an augmented reality (AR)-based fluorescence imaging system that provides users with a fluorescence image that matches the real-field, without requiring any additional algorithms. Commercial smart glasses, dichroic beam splitters, mirrors, and custom near-infrared cameras were employed to develop the proposed system, and each mount was designed and utilized. After its performance was assessed in the laboratory, preclinical experiments involving tumor detection and lung lobectomy in mice and rabbits by using indocyanine green (ICG) were conducted. The results showed that the proposed system provided a stable image of fluorescence that matched the actual site. In addition, preclinical experiments confirmed that the proposed system could be used to detect tumors using ICG and evaluate lung lobectomies. The AR-based intraoperative smart goggle system could detect fluorescence images for tumor margin assessments in animal models, without disrupting the surgical workflow in an operating room. Additionally, it was confirmed that, even when the system itself was distorted when worn, the fluorescence image consistently matched the actual site.
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Affiliation(s)
- Seung Hyun Lee
- Institute of Global Health Technology, College of Health Science, Korea University, Seoul 02841, Korea;
| | - Yu Hua Quan
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 02841, Korea; (Y.H.Q.); (B.H.C.)
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea
| | - Min Sub Kim
- Department of Bio-convergence Engineering, College of Health Science, Korea University, Seoul 02841, Korea;
| | - Ki Hyeok Kwon
- Department of Interdisciplinary Bio/Micro System Technology, College of Engineering, Korea University, Seoul 02841, Korea;
| | - Byeong Hyeon Choi
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 02841, Korea; (Y.H.Q.); (B.H.C.)
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea
| | - Hyun Koo Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 02841, Korea; (Y.H.Q.); (B.H.C.)
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea
- Correspondence: (H.K.K.); (B.-M.K.)
| | - Beop-Min Kim
- Department of Bioengineering, College of Health Science, Korea University, Seoul 02841, Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea
- Correspondence: (H.K.K.); (B.-M.K.)
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Kawakami Y, Kondo K, Kawakita N, Matsuoka H, Toba H, Takizawa H, Yoshida M, Tangoku A. Long-term outcomes of sentinel node identification using indocyanine green in patients with lung cancer. Thorac Cancer 2020; 12:165-171. [PMID: 33219734 PMCID: PMC7812077 DOI: 10.1111/1759-7714.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sentinel node (SN) biopsy is used in the management of numerous cancers to avoid unnecessary lymphadenectomy. This was a clinical exploration/feasibility study of a novel identification technique for SN biopsy using indocyanine green (ICG) fluorescence imaging during lung cancer surgery. METHODS SN biopsy using ICG was performed on 22 patients who had cT1 or T2N0M0 lung cancer. ICG was injected just around the primary tumor. The fluorescence imaging system enabled visualization of the lymphatic vessels draining from the primary tumor toward the lymph nodes. Fluorescently labeled nodes were dissected, and patients were followed-up for prognosis and recurrence to confirm the pattern of lymph node metastasis after surgery. RESULTS SNs were successfully identified in 16 (72.7%) of 22 patients. A total of 13 of 16 patients had pathological N0 and three had SN metastasis. The median follow-up time was 92.7 months. Only one patient had no SN metastasis at the postoperative pathological examination and lymph node metastasis during the follow-up period. The accuracy rate was 93.8% (15/16) and the false-negative rate was 7.7% (1/13). CONCLUSIONS SNs were identified by ICG fluorescence imaging, and this technique during lung cancer surgery had good identification and accuracy rates throughout the follow-up period. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: We attempted to identify sentinel lymph nodes by indocyanine green in lung cancer surgery. The identification rate was 72.7%. The accuracy rate was 100% immediately after surgery, and 93.8% after follow-up. WHAT THIS STUDY ADDS Sentinel node biopsy by indocyanine green may be useful for lymph node dissection during lung cancer surgery to avoid unnecessary lymphadenectomy.
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Affiliation(s)
- Yukikiyo Kawakami
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hisashi Matsuoka
- Department of Thoracic Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Finding the "True" N0 Cohort: Technical Aspects of Near-infrared Sentinel Lymph Node Mapping in Non-small Cell Lung Cancer. Ann Surg 2020; 272:583-588. [PMID: 32657925 DOI: 10.1097/sla.0000000000004176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine technical-, patient-, tumor-, and treatment-related factors associated with NIR guided SLN identification. BACKGROUND Missed nodal disease correlates with recurrence in early stage NSCLC. NIR-guided SLN mapping may improve staging and outcomes through identification of occult nodal disease. METHODS Retrospective analysis of 2 phase I clinical trials investigating NIR-guided SLN mapping utilizing ICG in patients with surgically resectable NSCLC. RESULTS In total, 66 patients underwent NIR-guided SLN mapping and lymphadenectomy after peritumoral ICG injection. There was significantly increased likelihood of SLN identification with injection dose ≥1 mg compared to <1 mg (65.2% vs 35.0%, P = 0.05), lung ventilation after injection (65.2% vs 35.0%, P = 0.05), and albumin dissolvent (68.1%) compared to fresh frozen plasma (28.6%) and sterile water (20.0%) (P = 0.01). In patients receiving the optimized ICG injection, there was significantly increased likelihood of SLN identification with radiologically solid nodules compared to sub-solid nodules (77.4% vs 33.3%, P = 0.04) and anatomic resection compared to wedge resection (88.2% vs 52.2%, P = 0.04). Disease-free and overall survival are 100% in those with a histologically negative SLN identified (n = 25) compared to 73.6% (P = 0.02) and 63.6% (P = 0.01) in patients with node negative NSCLC established via routine lymphadenectomy alone (n = 22). CONCLUSIONS SLN(s) are more reliably identified with ICG dose ≥1 mg, albumin dissolvent, post-injection lung ventilation, radiologically solid nodules, and anatomic resections. To date, N0 status when established via NIR SLN mapping seems to be associated with decreased recurrence and improved survival after surgery for NSCLC.
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20
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Gregor A, Ujiie H, Yasufuku K. Sentinel lymph node biopsy for lung cancer. Gen Thorac Cardiovasc Surg 2020; 68:1061-1078. [PMID: 32661834 DOI: 10.1007/s11748-020-01432-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Sentinel lymph node biopsy is a technique to identify the first lymph node (or nodes) draining a tumor. The underlying principle is that as the first site of cancer spread, evaluation of the sentinel node will be most predictive for wider nodal involvement. The introduction of sentinel node biopsy revolutionized the surgical management of cutaneous melanoma and breast cancer, becoming a key component in the management of such patients. For over 20 years, thoracic surgeons have similarly worked to apply this technique to lung cancer but have thus far not had the same impact on lung surgery. In this review, we will summarize the ongoing discussions on the role of sentinel node biopsy in lung cancer, the methods for identifying the sentinel node, and the techniques for evaluating the sentinel node specimen. We will also highlight some of the pressing questions investigators should consider when designing a trial for sentinel node mapping. This will clarify the current status of sentinel node biopsy in lung cancer and thus highlight important future directions for research.
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Affiliation(s)
- Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. .,Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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21
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Sun WYL, Dang JT, Modasi A, Nasralla A, Switzer NJ, Birch D, Turner SR, Karmali S. Diagnostic accuracy of sentinel lymph node biopsy using indocyanine green in lung cancer: a systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 2020; 68:905-913. [PMID: 32557077 DOI: 10.1007/s11748-020-01400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The use of sentinel lymph node biopsy (SLNB) has been gaining popularity with the emergence of indocyanine green (ICG) fluorescence imaging. We aimed to systematically review the literature and perform a meta-analysis on the diagnostic accuracy of SLNB using ICG for lung cancer. METHODS A comprehensive search of MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms "lung/pulmonary" AND "tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy/squamous/carcinoid" AND "indocyanine green" was completed in June 2018. Articles were selected based on the following inclusion criteria: (1) diagnostic accuracy study design; (2) ICG injected at the tumor site with near-infrared fluorescence imaging identification of sentinel lymph nodes; (3) lymphadenectomy or sampling was performed as the gold standard. RESULTS Eight primary studies were included with a total of 366 patients. 43.0% of patients were females and the mean tumor size was 2.3 cm. Sentinel lymph nodes were identified with ICG in 251 patients, yielding a pooled identification rate of 0.83 (0.67-0.94). A meta-analysis of seven studies computed a diagnostic odds ratio, sensitivity, and specificity of 177.6 (45.6-691.1), 0.85 (0.71-0.94), and 1.00 (0.98-1.00), respectively. The summary receiver operator characteristic demonstrated an area under the curve of 0.963 (SE = 0.038) and a Q* of 0.91 (SE = 0.057). CONCLUSION Our review found suboptimal results for the diagnostic accuracy of SLNB using ICG and must be improved before routine clinical use. Further research is required to develop a robust protocol for the use SLNB with ICG for lung cancer.
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Affiliation(s)
- Warren Y L Sun
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.
| | - Jerry T Dang
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada
| | - Aryan Modasi
- Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Awrad Nasralla
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada
| | - Noah J Switzer
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Daniel Birch
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
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22
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Affiliation(s)
- William W Phillips
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02115
| | - Yolonda L Colson
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02115.
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23
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Papayan G, Goncharov S, Kazakov N, Strui A, Akopov A. Clinical potential of photodynamic diagnosis and therapy of tracheobronchial malignancies in the visible and infrared spectral ranges. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.201900019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Garry Papayan
- Pavlov First State Medical University Saint‐Petersburg Russia
- Almazov Federal Medical Research Center Saint‐Petersburg Russia
| | | | - Nikita Kazakov
- Pavlov First State Medical University Saint‐Petersburg Russia
| | - Andrey Strui
- Pavlov First State Medical University Saint‐Petersburg Russia
| | - Andrey Akopov
- Pavlov First State Medical University Saint‐Petersburg Russia
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24
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Matsuura Y, Ichinose J, Nakao M, Okumura S, Mun M. Recent fluorescence imaging technology applications of indocyanine green in general thoracic surgery. Surg Today 2019; 50:1332-1342. [PMID: 31664525 DOI: 10.1007/s00595-019-01906-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/20/2019] [Indexed: 12/19/2022]
Abstract
Thoracic surgeons perform a wide variety of cancer operations, which are often associated with high morbidity and mortality. Thus, thoracic surgery involves many special challenges that require innovative solutions. The increased utilization of minimally invasive practices, poor overall cancer survival, and significant morbidity of critical operations remain key obstacles to overcome. Fluorescence imaging technology (FIT), involving the implementation of fluorescent dyes and imaging systems, is currently used as an adjunct for general thoracic surgery in many situations and includes sentinel lymph node mapping, pulmonary intersegmental plane identification, pulmonary nodule identification, pulmonary bullous lesion detection, evaluation of the anastomotic perfusion after tracheal surgery, and thoracic duct imaging for postoperative chylothorax. This technology enhances the surgeon's ability to perform operations, and has specific advantages. We review some of the key studies that demonstrate the applications of FIT in the field of general thoracic surgery, focusing on the use of indocyanine green.
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Affiliation(s)
- Yosuke Matsuura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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25
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Ferrari-Light D, Geraci TC, Sasankan P, Cerfolio RJ. The Utility of Near-Infrared Fluorescence and Indocyanine Green During Robotic Pulmonary Resection. Front Surg 2019; 6:47. [PMID: 31448283 PMCID: PMC6696346 DOI: 10.3389/fsurg.2019.00047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/23/2019] [Indexed: 12/17/2022] Open
Abstract
During minimally invasive pulmonary resection, it is often difficult to localize pulmonary nodules that are small (<2 cm), low-density/subsolid on imaging, or deep to the visceral pleura. The use of near-infrared fluorescence (NIF) imaging for localizing pulmonary nodules using indocyanine green (ICG) contrast is an emerging technology that is increasingly utilized during pulmonary resection. When administered via electromagnetic navigational bronchoscopy (ENB), ICG can accurately localize pulmonary nodules. When injected intravenously (IV), ICG can also help delineate the intersegmental plane. Research is ongoing regarding the utility of ICG for identification of the sentinel lymph node in lung cancer.
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Affiliation(s)
- Dana Ferrari-Light
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Prabhu Sasankan
- School of Medicine, New York University Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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26
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Zhang Z, Miao J, Chen Q, Fu Y, Li H, Hu B. Assessment of non-lobe-specific lymph node metastasis in clinical stage IA non-small cell lung cancer. Thorac Cancer 2019; 10:1597-1604. [PMID: 31206253 PMCID: PMC6610282 DOI: 10.1111/1759-7714.13121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The rationality of selective mediastinal lymph node dissection based on lobe-specific metastasis is still controversial. The correlation of lymph node metastasis in lobe-specific lymphatic drainage regions (LSDRs) and non-LSDRs has not been widely reported. The purpose of this study was to investigate the variables affecting nodal metastasis in non-LSDRs and to further evaluate the rationality of selective lymphadenectomy in clinical stage IA non-small cell lung cancer (NSCLC) patients. METHODS The clinicopathological information of 316 patients with clinical stage IA NSCLC who underwent lobectomy with systematic lymph node dissection between June 2014 and June 2018 was retrospectively collected for analysis. RESULTS The overall lymph node metastasis rate was 19.3%. For 35 patients with positive LSDR lymph nodes, the non-LSDR lymph node metastasis rate was 31.4%. Only one patient (0.4%) among 281 patients with negative LSDR lymph nodes had nodal spread in non-LSDRs. Univariate analysis identified that solid consistency, worse differentiation, and positive status in LSDRs were unfavorable predictive variables of lymph node metastasis in non-LSDRs. Multivariate analysis showed that nodal metastasis in LSDRs was the only independent predictor of nodal involvement in non-LSDRs (P < 0.001). CONCLUSION For patients with clinical stage IA NSCLC, non-LSDR lymph node metastasis mainly depends on the involvement of the LSDR lymph node. Our observations may indicate the potential implications for the reasonable management of lymphadenectomy in stage IA NSCLC patients.
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Affiliation(s)
- Zhirong Zhang
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qirui Chen
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yili Fu
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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27
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Clinical significance of epithelial–mesenchymal transition-related markers expression in the micrometastatic sentinel lymph node of NSCLC. Clin Transl Oncol 2019; 22:381-391. [DOI: 10.1007/s12094-019-02138-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/21/2019] [Indexed: 12/25/2022]
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28
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Okusanya OT, Hess NR, Luketich JD, Sarkaria IS. Infrared intraoperative fluorescence imaging using indocyanine green in thoracic surgery. Eur J Cardiothorac Surg 2019; 53:512-518. [PMID: 29029002 DOI: 10.1093/ejcts/ezx352] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/30/2017] [Indexed: 01/21/2023] Open
Abstract
Thoracic surgery faces many unique challenges that require innovative solutions. The increase in utilization of minimally invasive practices, poor overall cancer survival and significant morbidity of key operations remain key obstacles to overcome. Intraoperative fluorescence imaging is a process by which fluorescent dyes and imaging systems are used as adjuncts for surgeons in the operating room. Other surgical subspecialists have shown that intraoperative fluorescence imaging can be applied as a practical adjunct to their practices. Thoracic surgeons over the last 15 years have also used intraoperative fluorescence imaging for sentinel lymph node mapping, lung mapping, oesophageal conduit vascular perfusion and lung nodule identification. This review describes some of the key studies that demonstrate the applications of intraoperative near-infrared fluorescence imaging.
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Affiliation(s)
- Olugbenga T Okusanya
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas R Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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29
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Chao YK. Deciding to trust, coming to believe: sentinel lymph node assessment in lung cancer. J Thorac Dis 2019; 10:S3978-S3980. [PMID: 30631532 DOI: 10.21037/jtd.2018.09.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan
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30
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Meacci E, Nachira D, Chiappetta M, Congedo MT, Petracca-Ciavarella L, Ferretti G, Margaritora S. Editorial on "Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer". J Thorac Dis 2019; 10:S3922-S3926. [PMID: 30631517 DOI: 10.21037/jtd.2018.09.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elisa Meacci
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Dania Nachira
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Marco Chiappetta
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Maria Teresa Congedo
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Leonardo Petracca-Ciavarella
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Gianmaria Ferretti
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Stefano Margaritora
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
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31
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Predina JD, Keating J, Newton A, Corbett C, Xia L, Shin M, Frenzel Sulyok L, Deshpande C, Litzky L, Nie S, Kucharczuk JC, Singhal S. A clinical trial of intraoperative near-infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection. Cancer 2018; 125:807-817. [PMID: 30561757 DOI: 10.1002/cncr.31851] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/19/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The management of most solid tumors of the anterior mediastinum involves complete resection. Because of their location near mediastinal structures, wide resection is not possible; therefore, surgeons must use subjective visual and tactile cues to determine disease extent. This clinical trial explored intraoperative near-infrared (NIR) imaging as an approach to improving tumor delineation during mediastinal tumor resection. METHODS Twenty-five subjects with anterior mediastinal lesions suspicious for malignancy were enrolled in an open-label feasibility trial. Subjects were administered indocyanine green (ICG) at a dose of 5 mg/kg, 24 hours before resection (via a technique called TumorGlow). The NIR imaging systems included Artemis (Quest, Middenmeer, the Netherlands) and Iridium (VisionSense Corp, Philadelphia, Pennsylvania). Intratumoral ICG uptake was evaluated. The clinical value was determined via an assessment of the ability of NIR imaging to detect phrenic nerve involvement or incomplete resection. Clinical and histopathologic variables were analyzed to determine predictors of tumor fluorescence. RESULTS No drug-related toxicity was observed. Optical imaging added a mean of 10 minutes to case duration. Among the subjects with solid tumors, 19 of 20 accumulated ICG. Fluorescent tumors included thymomas (n = 13), thymic carcinomas (n = 4), and liposarcomas (n = 2). NIR feedback improved phrenic nerve dissection (n = 4) and identified residual disease (n = 2). There were no false-positives or false-negatives. ICG preferentially accumulated in solid tumors; this was independent of clinical and pathologic variables. CONCLUSIONS NIR imaging for anterior mediastinal neoplasms is safe and feasible. This technology may provide a real-time tool capable of determining tumor extent and specifically identify phrenic nerve involvement and residual disease.
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Affiliation(s)
- Jarrod D Predina
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jane Keating
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Newton
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Corbett
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leilei Xia
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Shin
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lydia Frenzel Sulyok
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charuhas Deshpande
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leslie Litzky
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shuming Nie
- Department of Chemistry, University of Illinois, Urbana, Illinois
| | - John C Kucharczuk
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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32
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Wang Y, Xie D, Wang Z, Zhang X, Zhang Q, Wang Y, Newton AD, Singhal S, Cai H, Wang Y, Lu Q, Hu Q, Wang Z. Kinetics of indocyanine green: Optimizing tumor to normal tissue fluorescence in image-guided oral cancer surgery applications. Head Neck 2018; 41:1032-1038. [PMID: 30549410 DOI: 10.1002/hed.25541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/08/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The study aimed to define indocyanine green (ICG) kinetics to determine the optimal ICG dose and surgical time for near-infrared fluorescence-guided oral cancer surgery. METHODS Spectrometer and grayscale digital imaging were used to quantify the ICG kinetics in 12 patients with oral cancer. The fluorescence intensity and signal-to-background ratio (SBR) of tumor and normal tissue were tested at 1, 6, and 24 hours after ICG injection. RESULTS The greatest contrast in the fluorescence intensity between tumor and normal tissue was observed at 6 hours (P < .01), and of three dose groups (0.5, 0.75, and 1.0 mg/kg), 0.75 mg/kg showed the highest SBR (2.06 ± 0.23) after ICG injection. CONCLUSIONS Fluorescence quantification based on spectrometry and grayscale imaging could be effective in determining the optimal ICG dose and surgical time after ICG injection in this cohort of patients with oral cancer.
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Affiliation(s)
- Yuxin Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Diya Xie
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ziyang Wang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Xudong Zhang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Qian Zhang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Andrew D Newton
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Huiming Cai
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Yiqing Wang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Qian Lu
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Qingang Hu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhiyong Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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33
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Papayan G, Akopov A. Potential of indocyanine green near-infrared fluorescence imaging in experimental and clinical practice. Photodiagnosis Photodyn Ther 2018; 24:292-299. [DOI: 10.1016/j.pdpdt.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
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34
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Clinical Significance of Molecular Micrometastasis in the Sentinel Lymph Node of Early-stage Non-Small Cell Lung Cancer Patients. Am J Clin Oncol 2018; 41:1106-1112. [PMID: 29509594 DOI: 10.1097/coc.0000000000000432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Metastatic affectation of lymph node is the main prognostic factor in localized lung cancer. A pathologic study of the obtained samples, even after adequate lymphadenectomy, showed tumor relapses for 20% of stage I patients after oncological curative surgery. We evaluated the prognostic value of molecular micrometastasis in the sentinel lymph node of patients with early-stage lung cancer. PATIENTS AND METHODS The sentinel node was marked immediately after performing thoracotomy by peritumorally injecting 0.25 mCi of nanocoloid of albumin (Nanocol1) labeled with Tc-99m in 0.3 mL. Guided by a Navigator1 gammagraphic sensor, we proceeded to its resection. The RNA of the tissue was extracted, and the presence of genes CEACAM5, BPIFA1, and CK7 in mRNA was studied. The significant association between the presence of micrometastasis, clinicopathologic characteristics, and patients' outcome was assessed. RESULTS Eighty-nine stage I-II non-small cell lung cancer patients were included in the study. Of the 89 analyzed sentinel lymph nodes, 44 (49.4%) were positive for CK7, 24 (26.9%) for CEACAM5, and 17 (19.1%) for BPIFA1, whereas 10 (11.2%) were positive for the 3 analyzed genes. A survival analysis showed no significant relation between the presence of molecular micrometastasis in the sentinel node and patients' progression. CONCLUSIONS The molecular analysis of the sentinel node in patients with early-stage lung cancer shows node affectation in cases staged as stage I/II by hematoxylin-eosin or an immunohistochemical analysis. However, this nodal affectation was not apparently related to patients' outcome.
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Pop CF, Veys I, Gomez Galdon M, Moreau M, Larsimont D, Donckier V, Bourgeois P, Liberale G. Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced-stage ovarian cancer. J Surg Oncol 2018; 118:1163-1169. [DOI: 10.1002/jso.25263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/08/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Catalin-Florin Pop
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Isabelle Veys
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Maria Gomez Galdon
- Department of Pathology; Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Michel Moreau
- Department of Data Centre and Statistics; Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Denis Larsimont
- Department of Pathology; Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Vincent Donckier
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Pierre Bourgeois
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles; Brussels Belgium
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Newton AD, Predina JD, Nie S, Low PS, Singhal S. Intraoperative fluorescence imaging in thoracic surgery. J Surg Oncol 2018; 118:344-355. [PMID: 30098293 DOI: 10.1002/jso.25149] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Abstract
Intraoperative fluorescence imaging (IFI) can improve real-time identification of cancer cells during an operation. Phase I clinical trials in thoracic surgery have demonstrated that IFI with second window indocyanine green (TumorGlow® ) can identify subcentimeter pulmonary nodules, anterior mediastinal masses, and mesothelioma, while the use of a folate receptor-targeted near-infrared agent, OTL38, can improve the specificity for diagnosing tumors with folate receptor expression. Here, we review the existing preclinical and clinical data on IFI in thoracic surgery.
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Affiliation(s)
- Andrew D Newton
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jarrod D Predina
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Shuming Nie
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, Indiana
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Predina JD, Newton A, Corbett C, Xia L, Sulyok LF, Shin M, Deshpande C, Litzky L, Barbosa E, Low PS, Kucharczuk JC, Singhal S. Localization of Pulmonary Ground-Glass Opacities with Folate Receptor-Targeted Intraoperative Molecular Imaging. J Thorac Oncol 2018; 13:1028-1036. [PMID: 29626619 PMCID: PMC6015787 DOI: 10.1016/j.jtho.2018.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Intraoperative localization and resection of ill-defined pulmonary ground-glass opacities (GGOs) during minimally invasive pulmonary resection is technically challenging. Current preoperative techniques to facilitate localization of GGOs include microcoil and hook wire placement, both of which have logistic limitations, carry safety concerns, and do not help with margin assessment. In this clinical trial, we explored an alternative method involving near-infrared molecular imaging with a folate receptor-targeted agent, OTL38, to improve localization of GGOs and confirmation of resection margins. METHODS In a human trial, 20 subjects with pulmonary GGOs who were eligible for video-assisted thoracoscopic surgery (VATS) resection received 0.025 mg/kg of OTL38 before the resection. The primary objectives were to (1) determine whether use of OTL38 allows safe localization of GGOs and assessment of margins during VATS and (2) determine patient, radiographic, and histopathologic variables that predict the amount of fluorescence during near-infrared imaging. RESULTS We observed no toxicity. Of the 21 GGOs, 20 accumulated OTL38 and displayed fluorescence upon in situ or back table evaluation. Intraoperatively, near-infrared imaging localized 15 of 21 lesions whereas VATS alone localized 10 of 21 (p = 0.05). The addition of molecular imaging affected care of nine of 21 subjects by improving intraoperative localization (n = 6) and identifying close margins (n = 3). This approach was most effective for subpleural lesions measuring less than 2 cm. For lesions deeper than 1.5 cm from the pleural surface, intraoperative localization using fluorescent feedback was limited. CONCLUSIONS This approach provides a safe alternative for intraoperative localization of small, peripherally located pulmonary lesions. In contrast to alternative localization techniques, use of OTL38 also allows confirmation of adequate margins. Future studies will compare this approach to alternative localization techniques in a clinical trial.
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Affiliation(s)
- Jarrod D Predina
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Newton
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Corbett
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leilei Xia
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lydia Frenzel Sulyok
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Shin
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charuhas Deshpande
- Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leslie Litzky
- Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eduardo Barbosa
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philip S Low
- Department of Chemistry, Purdue University, West Lafayette, Indiana; Purdue Institute for Drug Discovery, Purdue University, West Lafayette, Indiana
| | - John C Kucharczuk
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Center for Precision Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Detection of alternative subpleural lymph flow pathways using indocyanine green fluorescence. Surg Today 2018; 48:640-648. [DOI: 10.1007/s00595-018-1631-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/05/2018] [Indexed: 12/31/2022]
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Digesu CS, Hachey KJ, Gilmore DM, Khullar OV, Tsukada H, Whang B, Chirieac LR, Padera RF, Jaklitsch MT, Colson YL. Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer. J Thorac Cardiovasc Surg 2017; 155:1280-1291. [PMID: 29248292 DOI: 10.1016/j.jtcvs.2017.09.150] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/01/2017] [Accepted: 09/16/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To report the first analysis of long-term outcomes using near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping in non-small cell lung cancer (NSCLC). METHODS Retrospective analysis of patients with NSCLC enrolled in 2 prospective phase 1 NIR-guided SLN mapping trials, including an indocyanine green (ICG) dose-escalation trial, was performed. All patients underwent NIR imaging for SLN identification followed by multistation mediastinal lymph node sampling (MLNS) and pathologic assessment. Disease-free (DFS) and overall survival (OS) were compared between patients with NIR+ SLN (SLN group) and those without (non-SLN group). RESULTS SLN detection, recurrence, DFS, and OS were assessed in 42 patients with NSCLC who underwent intraoperative peritumoral ICG injection, NIR imaging, and MLNS. NIR+ SLNs were identified in 23 patients (SLN group), whereas SLNs were not identified in 19 patients enrolled before ICG dose and camera optimization (non-SLN group). Median follow-up was 44.5 months. Pathology from NIR+ SLNs was concordant with overall nodal status in all 23 patients. Sixteen patients with SLN were deemed pN0 and no recurrences were, whereas 4 of 15 pN0 non-SLN patients developed nodal or distant recurrent disease. Comparing SLN versus non-SLN pN0 patients, the probability of 5-year OS is 100% versus 70.0% (P = .062) and 5-year DFS is statistically significantly improved at 100% versus 66.1% (P = .036), respectively. Among the 11 pN+ patients, 7 were in the SLN group, with >40% showing metastases in the SLN alone. CONCLUSIONS Patients with pN0 SLNs showed favorable disease-free and overall survival. This preliminary review of NIR SLN mapping in NSCLC suggests that pN0 SLNs may better represent true N0 status. A larger clinical trial is planned to validate these findings.
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Affiliation(s)
| | | | - Denis M Gilmore
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Hisashi Tsukada
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Brian Whang
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | - Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, Mass
| | | | - Yolonda L Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
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Bronchoscopically Placed Dye Marking for Minimally Invasive Thoracic Surgery: A Surgeon’s Perspective. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/cpm.0000000000000232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Digesu CS, Colson YL. A "green" light for staging in early lung cancer. J Thorac Cardiovasc Surg 2017; 154:1134-1136. [PMID: 28826145 DOI: 10.1016/j.jtcvs.2017.05.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022]
Affiliation(s)
| | - Yolonda L Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
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42
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A novel minimally invasive near-infrared thoracoscopic localization technique of small pulmonary nodules: A phase I feasibility trial. J Thorac Cardiovasc Surg 2017; 154:702-711. [DOI: 10.1016/j.jtcvs.2017.03.140] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 02/12/2017] [Accepted: 03/06/2017] [Indexed: 11/22/2022]
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Nguyen DM, Villamizar N. "One-stop shop" tumor tattooing and sentinel lymph node mapping: A new paradigm for lung cancer therapy. J Thorac Cardiovasc Surg 2017. [PMID: 28629837 DOI: 10.1016/j.jtcvs.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dao M Nguyen
- Thoracic Surgery Section, Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, The Leonard Miller School of Medicine, University of Miami, Miami, Fla.
| | - Nestor Villamizar
- Thoracic Surgery Section, Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, The Leonard Miller School of Medicine, University of Miami, Miami, Fla
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Abbas A, Kadakia S, Ambur V, Muro K, Kaiser L. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg 2017; 153:1581-1590. [DOI: 10.1016/j.jtcvs.2016.12.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/11/2016] [Accepted: 12/03/2016] [Indexed: 02/07/2023]
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Helminen O, Mrena J, Sihvo E. Near-infrared image-guided lymphatic mapping in minimally invasive oesophagectomy of distal oesophageal cancer. Eur J Cardiothorac Surg 2017; 52:952-957. [DOI: 10.1093/ejcts/ezx141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/07/2017] [Indexed: 01/17/2023] Open
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Quang TT, Kim HY, Bao FS, Papay FA, Edwards WB, Liu Y. Fluorescence Imaging Topography Scanning System for intraoperative multimodal imaging. PLoS One 2017; 12:e0174928. [PMID: 28437441 PMCID: PMC5402944 DOI: 10.1371/journal.pone.0174928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/18/2017] [Indexed: 02/05/2023] Open
Abstract
Fluorescence imaging is a powerful technique with diverse applications in intraoperative settings. Visualization of three dimensional (3D) structures and depth assessment of lesions, however, are oftentimes limited in planar fluorescence imaging systems. In this study, a novel Fluorescence Imaging Topography Scanning (FITS) system has been developed, which offers color reflectance imaging, fluorescence imaging and surface topography scanning capabilities. The system is compact and portable, and thus suitable for deployment in the operating room without disturbing the surgical flow. For system performance, parameters including near infrared fluorescence detection limit, contrast transfer functions and topography depth resolution were characterized. The developed system was tested in chicken tissues ex vivo with simulated tumors for intraoperative imaging. We subsequently conducted in vivo multimodal imaging of sentinel lymph nodes in mice using FITS and PET/CT. The PET/CT/optical multimodal images were co-registered and conveniently presented to users to guide surgeries. Our results show that the developed system can facilitate multimodal intraoperative imaging.
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Affiliation(s)
- Tri T. Quang
- Department of Biomedical Engineering, the University of Akron, Akron, Ohio, United States of America
| | - Hye-Yeong Kim
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Forrest Sheng Bao
- Department of Electrical and Computer Engineering, the University of Akron, Akron, Ohio, United States of America
| | - Francis A. Papay
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - W. Barry Edwards
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (YL); (WBE)
| | - Yang Liu
- Department of Biomedical Engineering, the University of Akron, Akron, Ohio, United States of America
- * E-mail: (YL); (WBE)
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Hachey KJ, Digesu CS, Armstrong KW, Gilmore DM, Khullar OV, Whang B, Tsukada H, Colson YL. A novel technique for tumor localization and targeted lymphatic mapping in early-stage lung cancer. J Thorac Cardiovasc Surg 2017; 154:1110-1118. [PMID: 28274559 DOI: 10.1016/j.jtcvs.2016.12.058] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate safety and feasibility of navigational bronchoscopy (NB)-guided near-infrared (NIR) localization of small, ill-defined lung lesions and sentinel lymph nodes (SLN) for accurate staging in patients with non-small cell lung cancer (NSCLC). METHODS Patients with known or suspected stage I NSCLC were enrolled in a prospective pilot trial for lesion localization and SLN mapping via NB-guided NIR marking. Successful localization, SLN detection rates, histopathologic status of SLN versus overall nodes, and concordance to initial clinical stage were measured. Ex vivo confirmation of NIR+ SLNs and adverse events were recorded. RESULTS Twelve patients underwent NB-guided marking with indocyanine green of lung lesions ranging in size from 0.4 to 2.2 cm and located 0.1 to 3 cm from the pleural surface. An NIR+ "tattoo" was identified in all cases. Ten patients were diagnosed with NSCLC and 9 SLNs were identified in 8 of the 10 patients, resulting in an 80% SLN detection rate. SLN pathologic status was 100% sensitive and specific for overall nodal status with no false-negative results. Despite previous nodal sampling, one patient was found to have metastatic disease in the SLN alone, a 12.5% rate of disease upstaging with NIR SLN mapping. SLN were detectable for up to 3 hours, allowing time for obtaining a tissue diagnosis and surgical resection. There were no adverse events associated with NB-labeling or indocyanine green dye itself. CONCLUSIONS NB-guided NIR lesion localization and SLN identification was safe and feasible. This minimally invasive image-guided technique may permit the accurate localization and nodal staging of early stage lung cancers.
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Affiliation(s)
- Krista J Hachey
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | | | - Denis M Gilmore
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Onkar V Khullar
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Brian Whang
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Hisashi Tsukada
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Yolonda L Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
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Digesu CS, Hofferberth SC, Grinstaff MW, Colson YL. From Diagnosis to Treatment: Clinical Applications of Nanotechnology in Thoracic Surgery. Thorac Surg Clin 2016; 26:215-28. [PMID: 27112260 PMCID: PMC4851727 DOI: 10.1016/j.thorsurg.2015.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nanotechnology is an emerging field with potential as an adjunct to cancer therapy, particularly thoracic surgery. Therapy can be delivered to tumors in a more targeted fashion, with less systemic toxicity. Nanoparticles may aid in diagnosis, preoperative characterization, and intraoperative localization of thoracic tumors and their lymphatics. Focused research into nanotechnology's ability to deliver both diagnostics and therapeutics has led to the development of nanotheranostics, which promises to improve the treatment of thoracic malignancies through enhanced tumor targeting, controlled drug delivery, and therapeutic monitoring. This article reviews nanoplatforms, their unique properties, and the potential for clinical application in thoracic surgery.
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Affiliation(s)
- Christopher S Digesu
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA 02115, USA
| | - Sophie C Hofferberth
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA 02115, USA
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Metcalf Science Center, Boston University, SCI 518, 590 Commonwealth Avenue, Boston, MA 02215, USA; Department of Chemistry, Metcalf Science Center, Boston University, SCI 518, 590 Commonwealth Avenue, Boston, MA 02215, USA; Department of Medicine, Metcalf Science Center, Boston University, SCI 518, 590 Commonwealth Avenue, Boston, MA 02215, USA
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA 02115, USA; Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02155, USA.
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QIAO WENLIANG, HU HAIYANG, SHI BOWEN, ZANG LIJUAN, JIN WEI, LIN QIANG. Lentivirus-mediated knockdown of TSP50 suppresses the growth of non-small cell lung cancer cells via G0/G1 phase arrest. Oncol Rep 2016; 35:3409-18. [DOI: 10.3892/or.2016.4763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 11/05/2022] Open
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50
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Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer. J Thorac Cardiovasc Surg 2016; 152:546-54. [PMID: 27179838 DOI: 10.1016/j.jtcvs.2016.04.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/27/2016] [Accepted: 04/03/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess safety and feasibility of an intraoperative, minimally invasive near-infrared (NIR) image-guided approach to lymphatic mapping in patients with esophageal cancer. METHODS Although local lymph nodes (LNs) are removed with the esophageal specimen, no techniques are available to identify the regional LNs (separate from the esophagus) during esophagectomy. We hypothesize that NIR imaging can identify regional LNs with the potential to improve staging and guide the extent of lymphadenectomy. Nine of the 10 patients enrolled had resectable esophageal adenocarcinoma and underwent NIR mapping following peritumoral submucosal injection of indocyanine green (ICG) alone or premixed in human serum albumin (ICG:HSA) before resection. NIR imaging was performed in situ and ex vivo. RESULTS In 6 of the 10 patients, intraoperative NIR imaging demonstrated an NIR signal at all tumors and in 2 to 6 NIR(+) regional LNs. NIR(+) LNs were not identified in 4 patients: 1 patient with occult stage IV disease, for whom further imaging was not performed and thus was excluded from analysis, and 3 patients in whom ICG was used without HSA. Identification of local LNs on the esophagus was obscured by a peritumoral background. Importantly, the pathological status of NIR(+) regional LNs reflected overall regional nodal status. CONCLUSIONS NIR lymphatic mapping is safe and feasible in patients with esophageal cancer and can identify regional LNs when ICG:HSA is used. Although more work is needed to improve background signals and local LN identification, intraoperative detection of regional NIR(+) LNs allows an in-depth histological analysis of LN basins not commonly scrutinized as part of the specimen and may improve the detection of occult nodal disease.
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