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Open Access 01-04-2011 | Colorectal Cancer

Clinical Translation of Ex Vivo Sentinel Lymph Node Mapping for Colorectal Cancer Using Invisible Near-Infrared Fluorescence Light

Authors: Merlijn Hutteman, MSc, Hak Soo Choi, PhD, J. Sven D. Mieog, MD, Joost R. van der Vorst, MD, Yoshitomo Ashitate, MD, Peter J. K. Kuppen, PhD, Marian C. van Groningen, MD, PhD, Clemens W. G. M. Löwik, PhD, Vincent T. H. B. M. Smit, MD, PhD, Cornelis J. H. van de Velde, MD, PhD, John V. Frangioni, MD, PhD, Alexander L. Vahrmeijer, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2011

Abstract

Background

Sentinel lymph node (SLN) mapping in colorectal cancer may have prognostic and therapeutic significance; however, currently available techniques are not optimal. We hypothesized that the combination of invisible near-infrared (NIR) fluorescent light and ex vivo injection could solve remaining problems of SLN mapping in colorectal cancer.

Methods

The FLARE imaging system was used for real-time identification of SLNs after injection of the NIR lymphatic tracer HSA800 in the colon and rectum of (n = 4) pigs. A total of 32 SLN mappings were performed in vivo and ex vivo after oncologic resection using an identical injection technique. Guided by these results, SLN mappings were performed in ex vivo tissue specimens of 24 consecutive colorectal cancer patients undergoing resection.

Results

Lymph flow could be followed in real-time from the injection site to the SLN using NIR fluorescence. In pigs, the SLN was identified in 32 of 32 (100%) of SLN mappings under both in vivo and ex vivo conditions. Clinically, SLNs were identified in all patients (n = 24) using the ex vivo strategy within 5 min after injection of fluorescent tracer. Also, 9 patients showed lymph node involvement (N1 disease). In 1 patient, a 3-mm mesenteric metastasis was found adjacent to a tumor-negative SLN.

Conclusions

The current pilot study shows proof of principle that ex vivo NIR fluorescence-guided SLN mapping can provide high-sensitivity, rapid, and accurate identification of SLNs in colon and rectum. This creates an experimental platform to test optimized, non-FDA-approved NIR fluorescent lymphatic tracers in a clinical setting.

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Title: Clinical Translation of Ex Vivo Sentinel Lymph Node Mapping for Colorectal Cancer Using Invisible Near-Infrared Fluorescence Light
Authors: Merlijn Hutteman, MSc
Hak Soo Choi, PhD
J. Sven D. Mieog, MD
Joost R. van der Vorst, MD
Yoshitomo Ashitate, MD
Peter J. K. Kuppen, PhD
Marian C. van Groningen, MD, PhD
Clemens W. G. M. Löwik, PhD
Vincent T. H. B. M. Smit, MD, PhD
Cornelis J. H. van de Velde, MD, PhD
John V. Frangioni, MD, PhD
Alexander L. Vahrmeijer, MD, PhD
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1426-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical Translation of Ex Vivo Sentinel Lymph Node Mapping for Colorectal Cancer Using Invisible Near-Infrared Fluorescence Light

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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