Intraoperative Fluorescence Imaging for Detection of Sentinel Lymph Nodes and Lymphatic Vessels during Open Prostatectomy using Indocyanine Green

Yuen, Keiji; Miura, Taito; Sakai, Iori; Kiyosue, Akiko; Yamashita, Masuo

doi:10.1016/j.juro.2015.01.008

Cited by 49 publications

(50 citation statements)

References 20 publications

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“…We summarised the reported findings from the different studies in Table 1 [6,7,11,13,14,26,[28][29][30][31]34,38]. In line with previous templates, most SLNs could be identified in the obturator, external/internal iliac and common iliac regions.…”

Section: Prostate Sentinel Lymph Node Detection By Anatomical Regionmentioning

confidence: 78%

“…At high concentration, the ICG fluorophore is dark green and generates similar lymphovascular staining patterns as blue dye, which enables visual detection of superficial lymph vessels and nodes [22,25]. In pelvic SLND, ICG is diluted to a pale green solution at concentrations between 0.05mg/ml and 2.5mg/ml prior to prostatic injection [6,7,23,[26][27][28][29][30] and activated to emit near-infrared fluorescence (NIRF) by an excitation light, itself in the near-infrared (NIR) spectrum. In a prospective study comparing ICG to 99m Tc in melanoma patients, Stoffels et al demonstrated a tissue penetrance of only 10-15mm with free-ICG, preventing detection of lymphatic pathways extending to deep tissues [22].…”

Section: Fluorescence Imagingmentioning

confidence: 99%

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Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

Munbauhal

Seisen

Gomez

et al. 2016

Cancer Treatment Reviews

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The sentinel lymph node dissection (SLND) concept relies on the accurate detection of primary nodal landing sites and could represent a major advancement towards accurate, non-invasive pelvic staging in prostate cancer (PCa). Different iterations of the technique have now been validated and reproduced mostly in large-volume centres. The existing evidence denotes the feasibility and sensitivity of SLND, with encouraging pre- and intraoperative detection rates of 98% and 96%. Yet, current surgical practice mandates a backup template dissection due to a false negative rate, up to 7.1%, of tracer-guided surgery. In practice, SLND failed to achieve nodal detection in up to 20% of pelvic sidewalls. Despite scarce validated evidence, current consensus mainly attributes these false negative cases to altered prostatic drainage secondary to malignant obliteration of lymphovascular structures. In parallel, multiple SLND studies have highlighted the complex and variable drainage pathways from the prostate, furthering the established anatomical atlases. The most promising approach may therefore rely in magnetic nanoparticles and PCa-targeting ligands. However, in the absence of a clear sentinel node or region for the prostate, formal SLND is difficult to integrate in routine surgical practice for now. As such, tracer-guided dissection is only used as a complementary intervention to highlight first- echelon nodes and aberrant lymphatic pathways found beyond the commonly adopted pelvic lymphadenectomy templates.

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Section: Prostate Sentinel Lymph Node Detection By Anatomical Regionmentioning

confidence: 78%

Section: Fluorescence Imagingmentioning

confidence: 99%

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

Munbauhal

Seisen

Gomez

et al. 2016

Cancer Treatment Reviews

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“…It is considered that these reports apply to cases of micrometastasis. Yuen et al reported that sentinel lymph nodes were located in the obturator fossa, internal and external iliac regions, and rarely in the common iliac and presacral regions (22). There is a possibility that several LNs in the external iliac and common iliac area determined PSA recurrence.…”

Section: Standardmentioning

confidence: 99%

Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer

et al. 2019

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The oncological benefit of pelvic lymph node dissection (PLND) for prostate cancer (PCa) remains unclear. The therapeutic effect of PLND on the elimination of microscopic metastases during radical prostatectomy (RP) for PCa was examined in the current study. A total of 348 Japanese patients with high-or intermediate-risk PCa without lymph node metastasis, who underwent antegrade RP at the Kyushu Cancer Center (Fukuoka, Japan) between August 1998 and May 2013 were retrospectively analyzed. The patients were divided into the standard (obturator + internal iliac nodes) group and the expanded (standard + additional nodes) group according to the extent of PLND. Preoperative and postoperative characteristics were also analyzed to determine the factors associated with prostate-specific antigen (PSA) failure. Standard and expanded PLND were performed in 70.9% (247/348) and 29.1% (101/348) of cases, respectively. The results revealed that preoperative PSA levels were the only marked difference between the two groups. No differences were observed in the other preoperative and postoperative characteristics. Furthermore, the rate of PSA recurrence in each group did not differ to a statistically significant extent (P=0.3622). Reducing the area of dissection from expanded PLND to standard PLND significantly reduced the number of dissected lymph nodes (P<0.0001). Additionally, the PSA level, clinical tumor stage, Gleason score of the biopsy specimen, pathological tumor stage and extent of PLND were all associated with PSA recurrence, as determined via multivariate Cox hazards regression analysis (P= 0.0177, P= 0.0023, P= 0.0027, P<0.0001 and P= 0.0164, respectively). In high-and intermediate-risk patients without lymph node metastasis, a greater number of lymph nodes were dissected when the extent of dissection was greater. Furthermore, the extent of PLND was a significantly associated with PSA failure. The results indicated that PLND exerted a therapeutic effect by eliminating microscopic pelvic lymph node metastases that were not detected by routine pathological examinations.

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“…Intraprostatic free Indocyanin Green (ICG) has been utilized clinically in prostatectomy as a lymphangiographic agent in the detection of sentinel lymph nodes and for delineation of prostate by limited diffusion (9, 10). However, use of free ICG is limited by the lack of biochemical specificity to prostate or prostate cancer, and suffers from dye spillage from handling or manipulating fluorescent tissue.…”

Section: Introductionmentioning

confidence: 99%

Fluorescent Image–Guided Surgery with an Anti-Prostate Stem Cell Antigen (PSCA) Diabody Enables Targeted Resection of Mouse Prostate Cancer Xenografts in Real Time

Sonn

Behesnilian

Jiang

et al. 2016

Clinical Cancer Research

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Purpose The inability to visualize cancer during prostatectomy contributes to positive margins, cancer recurrence, and surgical side effects. A molecularly targeted fluorescent probe offers the potential for real-time intra-operative imaging. The goal of this study was to develop a probe for image-guided prostate cancer surgery. Experimental Design An antibody fragment (cys-diabody, cDb) against prostate stem cell antigen (PSCA) was conjugated to a far-red fluorophore, Cy5. The integrity and binding of the probe to PSCA was confirmed by gel electrophoresis, size exclusion and flow cytometry, respectively. Subcutaneous models of PSCA-expressing xenografts were used to assess the biodistribution and in vivo kinetics, while an invasive intramuscular model was utilized to explore the performance of Cy5-cDb-mediated fluorescence guidance in representative surgical scenarios. Finally, a prospective, randomized study comparing surgical resection with and without fluorescent guidance was performed to determine if this probe could reduce the incidence of positive margins. Results Cy5-cDb demonstrated excellent purity, stability and specific binding to PSCA. In vivo imaging showed maximal signal-to-background ratios at 6 hours. In mice carrying PSCA+ and − dual xenografts, the mean fluorescence ratio of PSCA+/− tumors was 4.4:1. In surgical resection experiments, residual tumors <1mm that were missed on white light surgery were identified and resected using fluorescence guidance, which reduced the incidence of positive surgical margins (0/8) compared to white light surgery alone (7/7). Conclusions Fluorescently labeled cDb enables real-time in vivo imaging of prostate cancer xenografts in mice, and facilitates more complete tumor removal than conventional white light surgery alone.

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Intraoperative Fluorescence Imaging for Detection of Sentinel Lymph Nodes and Lymphatic Vessels during Open Prostatectomy using Indocyanine Green

Abstract: Intraoperative fluorescence imaging using indocyanine green during open prostatectomy enables the detection of lymphatic vessels and sentinel lymph nodes with high sensitivity. This novel method is technically feasible, safe and easy to apply with minimal additional operative time.

Cited by 49 publications

References 20 publications

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer

Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer

Fluorescent Image–Guided Surgery with an Anti-Prostate Stem Cell Antigen (PSCA) Diabody Enables Targeted Resection of Mouse Prostate Cancer Xenografts in Real Time

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