Near-infrared Intraoperative Molecular Imaging Can Identify Metastatic Lymph Nodes in Prostate Cancer

Xia, Leilei; Zeh, Ryan; Mizelle, Jack; Newton, Andrew D.; Predina, Jarrod D.; Nie, Shuming; Singhal, Sunil; Guzzo, Thomas J.

doi:10.1016/j.urology.2017.04.020

Cited by 10 publications

(11 citation statements)

References 26 publications

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“…23 FI using IV injection of ICG has been reported to be a new promising noninvasive technology for the detection of metastatic tumor cell deposits in LNs of head and neck cancer, hepatocellular carcinoma, colorectal cancer, and prostate cancer. 19,20,26,27 In our study, we have evaluated the appropriateness and the usefulness of this technique for patients with AOC.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

Pop

Veys

Galdón

et al. 2018

Journal of Surgical Oncology

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Background and objectives The aim of this study was to evaluate the role of indocyanine green (ICG) fluorescence imaging (FI) for the ex vivo detection of metastatic lymph nodes (LNs) in advanced stage ovarian cancer (AOC). Methods Paraffin‐embedded LNs from patients included in a previous ICG‐FI study (Protocol NCT01834469) were further assessed for fluorescence. Intravenous injection of ICG was delivered intraoperatively. Tumor‐to‐background ratios (TBRs) were calculated. Results A total of 675 LNs from 19 patients were analyzed. The mean LN number per patient was 29.3 (median: 24; range 2‐77). Seventy‐three LNs were malignant (10.8%), 602 were benign (89.2%). The mean TBR of all LNs was 1.5 (SD 0.8). With a cut‐off TBR of 1.3, the sensitivity, specificity, positive predictive, and negative predictive values of ICG‐FI for retroperitoneal LNs were 80%, 41%, 2.8%, and 99%, respectively. On univariate analysis, only the fluorescence ratio (TBR ≥ 1.3) was correlated with malignancy at pathology (P = 0.03). No predictive factors of pathological LN status were found on multivariate analysis. Conclusions Ex vivo ICG‐FI of retroperitoneal LNs in AOC had good sensitivity but poor specificity. However, its high negative predictive value could make it an appropriate complementary tool to focus pathological analysis on fluorescent LNs.

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Section: Discussionmentioning

confidence: 99%

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

Pop

Veys

Galdón

et al. 2018

Journal of Surgical Oncology

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“…Studies in metastatic gastrointestinal cancers have demonstrated sensitivities ranging from 76.3% - 87.5% 32,33 however limited conclusions can be drawn due to the lack of rigorous assessment of surrounding peritoneal and gastrointestinal tissues 33. Xia et al investigated ICG for the detection of metastatic pelvic lymph nodes in prostate cancer but did not report a sensitivity or specificity and notably one false negative lymph node was found in a sample of only four patients 34. Digonnet et al reported a higher sensitivity and specificity for metastatic nodes in head and neck cancers of 76.5% and 76.7% respectively which is still lower than our study, however also noted that near-infrared fluorescence imaging may be useful in assessing the margins of resections that appear normal in white light, a finding consistent with our data 35.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical accuracy which can be achieved using PYRO-FGR, most notably with respect to resection tumour margins, is another important finding. As Porphysomes are administered intravenously, the surgical field does not become contaminated with leaking dye which can be problematic with intra-lymphatic imaging agents such as ICG 34, meaning that margin resection can be performed in a highly accurate manner.…”

Section: Discussionmentioning

confidence: 99%

Use of Porphysomes to detect primary tumour, lymph node metastases, intra-abdominal metastases and as a tool for image-guided lymphadenectomy: proof of concept in endometrial cancer

Philp¹,

Chan²,

Rouzbahman³

et al. 2019

Theranostics

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Objective : To investigate Porphysome fluorescence image-guided resection (PYRO-FGR) for detection of uterine tumour, metastatic lymph nodes and abdominal metastases in a model of endometrial cancer. Methods : White New Zealand rabbits were inoculated with VX2 cells via intra-myometrial injection. At 30 days, Porphysomes were administered intravenously. At 24 h the abdomen was imaged and fluorescent tissue identified (PYRO-FGR). After complete resection of fluorescent tissue, fluorescence-negative lymph nodes and peritoneal biopsies were removed. Histopathology including ultra-staging and analysis by a pathologist was used to detect tumour. Fluorescence signal to background ratio (SBR) was calculated and VX2 (+) tissue compared to VX2 (-) tissue. Biodistribution was calculated and Porphysome accumulation in fluorescent VX2 (+) tissue compared to fluorescent VX2 (-) and non-fluorescent VX2 (-) tissue. Results : Of 17 VX2 models, 10 received 4 mg/kg of Porphysomes and 7 received 1 mg/kg. Seventeen tumours (UT), 81 lymph nodes (LN) and 54 abdominal metastases (AM) were fluorescence-positive and resected. Of these, 17 UT, 60 LN and 45 AM were VX2 (+), while 16 LN and 5 AM were VX2 (-). Nine specimens were excluded from analysis. Thirty-one LN and 53 peritoneal biopsies were fluorescence-negative and resected. Of these, all LN and 51/53 biopsies were VX2 (-) with only 2 false-negative biopsies. Sensitivity and specificity of PYRO-FGR for VX2 (+) tissue was 98.4% / 80.0% overall, 100% / 100% for UT, 100% / 66.0 % for LN and 95.7% / 91.4% for AM. Increased SBR and biodistribution was observed in VX2 (+) tissue vs. VX2 (-) tissue. Conclusions : Porphysomes are a highly sensitive imaging agent for intra-operative detection and resection of uterine tumour, metastatic lymph nodes and abdominal metastases.

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“…Barabino et al used a similar dose in patients with peritoneal carcinomatosis 24 h prior to surgery and found lower sensitivity and specificity of 72.4% and 60.0%, respectively which suggests that 24 h after a lower dose of ICG may be insufficient for optimal fluorescence enhancement. This is in comparison to the “second window” use of ICG, where larger amounts of the dye (5 mg/kg) are administered intravenously and imaged after 24 h. This approach has been useful for delineating a number of tumors including tumors in the pancreas [ 41 ], lung [ 41 , 42 ], brain [ 43 , 44 ], and prostate [ 45 ]. High dose ICG labeling was reported as feasible in one case report of a patient with pulmonary CRC metastasis, but this approach has not been used for direct labeling of CRC [ 46 ].…”

Section: Non-targeted Fluorescence Agentsmentioning

confidence: 99%

Fluorescence Molecular Targeting of Colon Cancer to Visualize the Invisible

Lwin

Turner

Amirfakhri

et al. 2022

Cells

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Colorectal cancer (CRC) is a common cause of cancer and cancer-related death. Surgery is the only curative modality. Fluorescence-enhanced visualization of CRC with targeted fluorescent probes that can delineate boundaries and target tumor-specific biomarkers can increase rates of curative resection. Approaches to enhancing visualization of the tumor-to-normal tissue interface are active areas of investigation. Nonspecific dyes are the most-used approach, but tumor-specific targeting agents are progressing in clinical trials. The present narrative review describes the principles of fluorescence targeting of CRC for diagnosis and fluorescence-guided surgery with molecular biomarkers for preclinical or clinical evaluation.

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Near-infrared Intraoperative Molecular Imaging Can Identify Metastatic Lymph Nodes in Prostate Cancer

Cited by 10 publications

References 26 publications

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

Ex vivo indocyanine green fluorescence imaging for the detection of lymph node involvement in advanced‐stage ovarian cancer

Use of Porphysomes to detect primary tumour, lymph node metastases, intra-abdominal metastases and as a tool for image-guided lymphadenectomy: proof of concept in endometrial cancer

Fluorescence Molecular Targeting of Colon Cancer to Visualize the Invisible

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