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Time-lapse imaging of sentinel lymph node using indocyanine green with near-infrared fluorescence imaging in early endometrial cancer. Video can be found with this article online at http://ejgo.org/src/sm/jgo-27-e27-s001.mp4.
Hyun Jin Choi
, Tae-Joong Kim, Yoo-Young Lee, Jeong-Won Lee, Byoung-Gie Kim, Duk-Soo Bae
, Tae-Joong Kim, Yoo-Young Lee, Jeong-Won Lee, Byoung-Gie Kim, Duk-Soo Bae
Abstract
Objective
Indocyanine green with near-infrared fluorescence imaging (NIR-ICG) is a new tracer modality in the limelight used for lymphatic mapping. The advantage of this method is to provide real-time image during surgery. To use ICG for image guided lymph node dissection, a surgeon needs to know initial appearing time and duration.
Methods
A 52-year-old woman undertook surgery diagnosed with endometrial cancer. She had no past medical history and her body mass index was 25.3 kg/m2. Preoperative magnetic resonance imaging examination revealed 2.7 cm sized cancerous mass in the endometrial cavity with superficial myometrial invasion without lymph node enlargement. Four mL (1.25 mg/mL) of ICG solution was prepared for injection. For each site, 1 mL of solution was injected superficially, 2–3 mm into the cervical submucosa and another 1 mL was injected deep, 1–2 cm into the stroma of the cervix [12]. We recorded video with 30° 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany).
Results
Pelvic lymph node was visualized from around 5 minutes. ICG was dispersed into organs after hysterectomy (53 minutes after ICG injection), yet we could clearly identify sentinel lymph node (SLN). Pathology revealed endometriod adenocarcinoma grade I, myometrial invasion with less than half of myometrium and no lymph node metastasis.
References
1. Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009; 113:163–172.
2. How J, Gotlieb WH, Press JZ, Abitbol J, Pelmus M, Ferenczy A, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015; 137:436–478.
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