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Lahav G, Shilstein S, Shchemelinin S, Ikher S, Halperin D, Chechik R, Breskin A. X-ray fluorescence-based differentiation of neck tissues in a bovine model: implications for potential intraoperative use. Phys Med 2015; 31:233-41. [PMID: 25677045 DOI: 10.1016/j.ejmp.2015.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/17/2022] Open
Abstract
This study explores the possibility of using X-ray fluorescence (XRF)-based trace-element analysis for differentiation of various bovine neck tissues. It is motivated by the requirement for an intra-operative in-vivo method for identifying parathyroid glands, particularly beneficial in surgery in the central neck-compartment. Using a dedicated X-ray spectral analysis, we examined ex-vivo XRF spectra from various histologically verified fresh neck tissues from cow, which was chosen as the animal model; these tissues included fat, muscle, thyroid, parathyroid, lymph nodes, thymus and salivary gland. The data for six trace elements K, Fe, Zn, Br, Rb and I, provided the basis for tissue identification by using multi-parameter analysis of the recorded XRF spectra. It is shown that the combination of XRF signals from these elements is sufficient for a reliable tissue differentiation. The average total abundance of these trace elements was evaluated in each tissue type, including parathyroid and salivary gland for the first time. It is shown that some tissues can unequivocally be identified on the basis of the abundance of a single element, for example, iodine and zinc for the identification of thyroid gland and muscle, respectively.
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Affiliation(s)
- G Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Centre, Rehovot, Israel
| | - S Shilstein
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel.
| | - S Shchemelinin
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - S Ikher
- Department of Pathology, Kaplan Medical Centre, Rehovot, Israel
| | - D Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Centre, Rehovot, Israel
| | - R Chechik
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - A Breskin
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
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Mokhtar M, Tadokoro Y, Nakagawa M, Morimoto M, Takechi H, Kondo K, Tangoku A. Triple assessment of sentinel lymph node metastasis in early breast cancer using preoperative CTLG, intraoperative fluorescence navigation and OSNA. Breast Cancer 2014; 23:202-10. [PMID: 25069434 DOI: 10.1007/s12282-014-0551-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) became a standard surgical procedure for patients with early breast cancer; however, the optimal method of sentinel lymph node (SLN) identification remains controversial. The current study presents the protocol of our institution for preoperative and intraoperative SLN detection. METHODS Fifty female patients with early breast cancer and clinically node-negative axilla were enrolled in this study. All patients underwent preoperative CT lymphography (CTLG), intraoperative SLNB using fluorescence navigation, intraoperative one-step nucleic acid amplification (OSNA) and postoperative hematoxylin and eosin histopathological analysis. Prediction of metastasis by CTLG and detection of metastasis by OSNA were compared to results of histopathology as standard reference. RESULTS SLN were identified by preoperative CTLG and intraoperative SLNB with fluorescence navigation in all patients, the identification rate was 100 %. SLN metastases were detected as positive by OSNA in 9 patients (18 %), 4 were (++), 4 were (+) and 1 was (+I). SLN metastases were detected as positive by histopathology in 10 patients (20 %). The concordance rate between OSNA and permanent sections was 90 %. The negative predictive value of CTLG was 80 %. CONCLUSION Use of CTLG and fluorescence navigation made performing SLNB with high accuracy possible in institutions that cannot use the radioisotope method. OSNA provided accurate intraoperative method, allowing for completion of axillary node dissection during surgery and avoidance of second surgical procedure in patients with positive SLNs, thereby reducing patient distress and, finally, saving hospital costs.
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Affiliation(s)
- Mohamed Mokhtar
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan.,Department of Oncological Surgery, Minia Oncology Institute, Minya, 61111, Egypt
| | - Yukiko Tadokoro
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan.
| | - Misako Nakagawa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Masami Morimoto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Hirokazu Takechi
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8505, Japan
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Kim KR, Lee YD, Lee T, Kim BS, Kim S, Ahn DR. Sentinel lymph node imaging by a fluorescently labeled DNA tetrahedron. Biomaterials 2013; 34:5226-35. [DOI: 10.1016/j.biomaterials.2013.03.074] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/23/2013] [Indexed: 01/02/2023]
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Eser M, Kement M, Kaptanoglu L, Gecer M, Abamor E, Tutal F, Balin S, Kurt N, Uzun H. A prospective comparative study to assess the contribution of radioisotope tracer method to dye-only method in the detection of sentinel lymph node in breast cancer. BMC Surg 2013; 13:13. [PMID: 23617459 PMCID: PMC3679879 DOI: 10.1186/1471-2482-13-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 03/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session. METHODS Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately. RESULTS At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1 ± 1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9 ± 1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection. CONCLUSION The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method.
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Aldrich MB, Guilliod R, Fife CE, Maus EA, Smith L, Rasmussen JC, Sevick-Muraca EM. Lymphatic abnormalities in the normal contralateral arms of subjects with breast cancer-related lymphedema as assessed by near-infrared fluorescent imaging. BIOMEDICAL OPTICS EXPRESS 2012; 3:1256-65. [PMID: 22741072 PMCID: PMC3370966 DOI: 10.1364/boe.3.001256] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/27/2012] [Accepted: 04/27/2012] [Indexed: 05/16/2023]
Abstract
Current treatment of unilateral breast cancer-related lymphedema (BCRL) is only directed to the afflicted arm. Near-infrared fluorescent imaging (NIRF) of arm lymphatic vessel architecture and function in BCRL and control subjects revealed a trend of increased lymphatic abnormalities in both the afflicted and unafflicted arms with increasing time after lymphedema onset. These pilot results show that BCRL may progress to affect the clinically "normal" arm, and suggest that cancer-related lymphedema may become a systemic, rather than local, malady. These findings support further study to understand the etiology of cancer-related lymphedema and lead to better diagnostics and therapeutics directed to the systemic lymphatic system.
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Affiliation(s)
- Melissa B. Aldrich
- Center for Molecular Imaging, The Brown Foundation Institute for Molecular Medicine, University of Texas Health Science Center-Houston, 1825 Pressler, 330A, Houston, TX 77030, USA
| | - Renie Guilliod
- Memorial Hermann Center for Wound Healing, Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Caroline E. Fife
- Memorial Hermann Center for Wound Healing, Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Erik A. Maus
- Memorial Hermann Center for Wound Healing, Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Latisha Smith
- Memorial Hermann Center for Wound Healing, Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - John C. Rasmussen
- Center for Molecular Imaging, The Brown Foundation Institute for Molecular Medicine, University of Texas Health Science Center-Houston, 1825 Pressler, 330A, Houston, TX 77030, USA
| | - Eva M. Sevick-Muraca
- Center for Molecular Imaging, The Brown Foundation Institute for Molecular Medicine, University of Texas Health Science Center-Houston, 1825 Pressler, 330A, Houston, TX 77030, USA
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Sun J, Yin J, Ning L, Liu J, Liu H, Gu L, Fu L. Clinicopathological characteristics of breast cancers with axillary skip metastases. J INVEST SURG 2012; 25:33-6. [PMID: 22272635 DOI: 10.3109/08941939.2011.598605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The presence of discontinuous or "skip" metastases in breast cancer is crucial for determining the optimal therapeutic choice. In this study, we compared the clinicopathological characteristics and prognosis of patients with or without skip metastases (SMs). METHODS We retrospectively analyzed the records of 1,502 breast cancer patients who underwent radical mastectomy and a separate group of 118 patients who had sentinel lymph node biopsies (SLNB). The median follow-up time was 10 years. RESULTS Axillary lymph nodes (ALN) were involved in 814/1502 patients, and SMs was found in 119 patients (14.6%). Age, tumor size, location, clinical stage, and the proportion of interpectoral lymph node (IPN) metastases were similar in patients with or without SMs (p > .05). In stage I and II disease, the event-free survival rate of patients with SMs was significantly lower than patients without (p < .05); there was no significant difference in stage III patients (p > .05). The Cox multivariate analysis showed that the tumor size, number of lymphatic metastases, lymph node involvement, and SMs were important prognostic factors. The false-negative rate of SLNB was 12.0% (3/25). CONCLUSION Axillary lymphatic SM is difficult to predict, but their presence can predict a poorer prognosis for stage I and II patients. SM could occur in SLNB-negative patients.
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Affiliation(s)
- Jingyan Sun
- Department of Breast Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Hexi District, Tianjin, China
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Cong L, Takeda M, Hamanaka Y, Gonda K, Watanabe M, Kumasaka M, Kobayashi Y, Kobayashi M, Ohuchi N. Uniform silica coated fluorescent nanoparticles: synthetic method, improved light stability and application to visualize lymph network tracer. PLoS One 2010; 5:e13167. [PMID: 20976187 PMCID: PMC2956628 DOI: 10.1371/journal.pone.0013167] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 08/05/2010] [Indexed: 12/22/2022] Open
Abstract
Background The sentinel lymph node biopsy (SLNB) was developed as a new modality in the surgical diagnosis of lymph node metastases. Dye and radioisotope are major tracers for the detection of sentinel lymph nodes (SLN). Dye tends to excessively infiltrate into the interstitium due to their small size (less than several nanometers), resulting in difficulties in maintaining clear surgical fields. Radioisotopes are available in limited number of hospitals. Fluorescent nanoparticles are good candidates for SLN tracer to solve these problems, as we can choose suitable particle size and fluorescence wavelength of near-infrared. However, the use of nanoparticles faces safety issues, and many attempts have been performed by giving insulating coats on nanoparticles. In addition, the preparation of the uniform insulating layer is important to decrease variations in the quality as an SLN tracer. Methodology/Principal Findings We herein succeeded in coating fluorescent polystyrene nanoparticles of 40 nm with uniform silica layer of 13 nm by the modified Stöber method. The light stability of silica coated nanoparticles was 1.3-fold greater than noncoated nanoparticles. The popliteal lymph node could be visualized by the silica coated nanoparticles with injection in the rat feet. Conclusions/Significance The silica coated nanoparticles in lymph nodes could be observed by transmission electron microscope, suggesting that our silica coating method is useful as a SLN tracer with highly precise distribution of nanoparticles in histological evaluation. We also demonstrated for the first time that a prolonged enhancement of SLN is caused by the phagocytosis of fluorescent nanoparticles by both macrophages and dendritic cells.
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Affiliation(s)
- Liman Cong
- Department of Nano-Medical Science, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Motohiro Takeda
- Department of Nano-Medical Science, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- * E-mail:
| | - Yohei Hamanaka
- Department of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Kohsuke Gonda
- Department of Nano-Medical Science, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Masutaka Kumasaka
- Department of Electronics and Intelligent Systems, Tohoku Institute of Technology, Sendai, Miyagi, Japan
| | - Yoshio Kobayashi
- Department of Biomolecular Functional Engineering, College of Engineering, Ibaraki University, Hitachi, Ibaraki, Japan
| | - Masaki Kobayashi
- Department of Electronics and Intelligent Systems, Tohoku Institute of Technology, Sendai, Miyagi, Japan
| | - Noriaki Ohuchi
- Department of Nano-Medical Science, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- Department of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
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Fluorescence imaging and whole-body biodistribution of near-infrared-emitting quantum dots after subcutaneous injection for regional lymph node mapping in mice. Mol Imaging Biol 2009; 12:394-405. [PMID: 19936843 DOI: 10.1007/s11307-009-0288-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/10/2009] [Accepted: 07/29/2009] [Indexed: 01/09/2023]
Abstract
PURPOSE This study compares fluorescence imaging to mass spectroscopy (inductively coupled plasma-mass spectroscopy, ICP-MS) for detection of quantum dots (QDs) in sentinel lymph node (LN) mapping of breast cancer. PROCEDURES We study the accumulation of near-infrared-emitting QDs into regional LNs and their whole-body biodistribution in mice after subcutaneous injection, using in vivo fluorescence imaging and ex vivo elemental analysis by ICP-MS. RESULTS We show that the QD accumulation in regional LNs is detectable by fluorescence imaging as early as 5 min post-delivery. Their concentration reaches a maximum at 4 h then decreases over a 10-day observation period. These data are confirmed by ICP-MS. The QD uptake in other organs, assessed by ICP-MS, increases steadily over time; however, its overall level remains rather low. CONCLUSIONS Fluorescence imaging can be used as a non-invasive alternative to ICP-MS to follow the QD accumulation kinetics into regional LNs.
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A prospective randomized trial: The influence of intraoperative application of fibrin glue after radical inguinal/iliacal lymph node dissection on postoperative morbidity. Eur J Surg Oncol 2009; 35:884-9. [DOI: 10.1016/j.ejso.2008.09.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 09/27/2008] [Accepted: 09/30/2008] [Indexed: 11/17/2022] Open
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Robe A, Pic E, Lassalle HP, Bezdetnaya L, Guillemin F, Marchal F. Quantum dots in axillary lymph node mapping: biodistribution study in healthy mice. BMC Cancer 2008; 8:111. [PMID: 18430208 PMCID: PMC2375898 DOI: 10.1186/1471-2407-8-111] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Accepted: 04/22/2008] [Indexed: 11/23/2022] Open
Abstract
Background Breast cancer is the first cause of cancer death among women and its incidence doubled in the last two decades. Several approaches for the treatment of these cancers have been developed. The axillary lymph node dissection (ALND) leads to numerous morbidity complications and is now advantageously replaced by the dissection and the biopsy of the sentinel lymph node. Although this approach has strong advantages, it has its own limitations which are manipulation of radioactive products and possible anaphylactic reactions to the dye. As recently proposed, these limitations could in principle be by-passed if semiconductor nanoparticles (quantum dots or QDs) were used as fluorescent contrast agents for the in vivo imaging of SLN. QDs are fluorescent nanoparticles with unique optical properties like strong resistance to photobleaching, size dependent emission wavelength, large molar extinction coefficient, and good quantum yield. Methods CdSe/ZnS core/shell QDs emitting around 655 nm were used in our studies. 20 μL of 1 μM (20 pmol) QDs solution were injected subcutaneously in the anterior paw of healthy nude mice and the axillary lymph node (ALN) was identified visually after injection of a blue dye. In vivo fluorescence spectroscopy was performed on ALN before the mice were sacrificed at 5, 15, 30, 60 min and 24 h after QDs injection. ALN and all other organs were removed, cryosectioned and observed in fluorescence microscopy. The organs were then chemically made soluble to extract QDs. Plasmatic, urinary and fecal fluorescence levels were measured. Results QDs were detected in ALN as soon as 5 min and up to 24 h after the injection. The maximum amount of QDs in the ALN was detected 60 min after the injection and corresponds to 2.42% of the injected dose. Most of the injected QDs remained at the injection site. No QDs were detected in other tissues, plasma, urine and feces. Conclusion Effective and rapid (few minutes) detection of sentinel lymph node using fluorescent imaging of quantum dots was demonstrated. This work was done using very low doses of injected QDs and the detection was done using a minimally invasive method.
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Affiliation(s)
- Anne Robe
- CRAN, Nancy-University, CNRS, Centre Alexis Vautrin, Avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy Cedex, France.
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