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

Abstract:

BACKGROUND:Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers. MATERIALS AND METHODS:A small, portable version of the FLARE imaging system, termed Mini-FLARE, was developed for capturing color video and two semi-independent channels of NIR fluorescence (700 and 800 nm) in real time. Initial optimization of lymphatic tracer dose was performed using 35-kg Yorkshire pigs and a 6-patient pilot clinical trial. More refined optimization was performed in 24 consecutive breast cancer patients. All patients received the standard of care using (99m)Technetium-nanocolloid and patent blue. In addition, 1.6 ml of indocyanine green adsorbed to human serum albumin (ICG:HSA) was injected directly after patent blue at the same location. Patients were allocated to 1 of 8 escalating ICG:HSA concentration groups from 50 to 1000 μM. RESULTS:The Mini-FLARE system was positioned easily in the operating room and could be used up to 13 in. from the patient. Mini-FLARE enabled visualization of lymphatic channels and SLNs in all patients. A total of 35 SLNs (mean = 1.45, range 1-3) were detected: 35 radioactive (100%), 30 blue (86%), and 35 NIR fluorescent (100%). Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN. Optimal injection dose of ICG:HSA ranged between 400 and 800 μM. No adverse reactions were observed. CONCLUSIONS:We describe the clinical translation of a new NIR fluorescence imaging system and define the optimal ICG:HSA dose range for SLN mapping in breast cancer.

journal_name

Ann Surg Oncol

authors

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

doi

10.1245/s10434-011-1566-x

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

2483-91

issue

9

eissn

1068-9265

issn

1534-4681

journal_volume

18

pub_type

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