17 February 2017 Sentinel lymph node detection in gynecologic malignancies by a handheld fluorescence camera
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Abstract
Near-infrared fluorescence imaging using indocyanine green (ICG) as a tracer is a promising technique for mapping the lymphatic system and for detecting sentinel lymph nodes (SLN) during cancer surgery. In our feasibility study we have investigated the application of a custom-made handheld fluorescence camera system for the detection of lymph nodes in gynecological malignancies. It comprises a low cost CCD camera with enhanced NIR sensitivity and two groups of LEDs emitting at wavelengths of 735 nm and 830 nm for interlaced recording of fluorescence and reflectance images of the tissue, respectively. With the help of our system, surgeons can observe fluorescent tissue structures overlaid onto the anatomical image on a monitor in real-time. We applied the camera system for intraoperative lymphatic mapping in 5 patients with vulvar cancer, 5 patients with ovarian cancer, 3 patients with cervical cancer, and 3 patients with endometrial cancer. ICG was injected at four loci around the primary malignant tumor during surgery. After a residence time of typically 15 min fluorescence images were taken in order to visualize the lymph nodes closest to the carcinomas. In cases with vulvar cancer about half of the lymph nodes detected by routinely performed radioactive SLN mapping have shown fluorescence in vivo as well. In the other types of carcinomas several lymph nodes could be detected by fluorescence during laparotomy. We conclude that our low cost camera system has sufficient sensitivity for lymphatic mapping during surgery.
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Ole Hirsch, Ole Hirsch, Lukasz Szyc, Lukasz Szyc, Mustafa Zelal Muallem, Mustafa Zelal Muallem, Iulia Ignat, Iulia Ignat, Radoslav Chekerov, Radoslav Chekerov, Rainer Macdonald, Rainer Macdonald, Jalid Sehouli, Jalid Sehouli, Ioana Braicu, Ioana Braicu, Dirk Grosenick, Dirk Grosenick, } "Sentinel lymph node detection in gynecologic malignancies by a handheld fluorescence camera", Proc. SPIE 10059, Optical Tomography and Spectroscopy of Tissue XII, 100591B (17 February 2017); doi: 10.1117/12.2250723; https://doi.org/10.1117/12.2250723
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