Optimization of sentinel lymph node mapping in bladder cancer using near-infrared fluorescence imaging

Abstract

Background and objectives Unlike other cancers, the Sentinel Lymph Node (SLN) procedure in bladder cancer requires special attention to the injection technique. The aim of this study was to assess feasibility and to optimize tracer injection technique for SLN mapping in bladder cancer patients using NIR fluorescence imaging. Methods Twenty patients with invasive bladder cancer scheduled for radical cystectomy were prospectively enrolled. Indocyanine green (ICG) bound to human serum albumin (complex ICG:HSA; 500 μM) was injected peritumourally to permit SLN mapping. ICG:HSA was first administrated serosally (n=5), and subsequently mucosally by cystoscopic injection (n=15). In the last cohort of 12 patients treated with cystoscopic injection, the bladder was kept filled with saline for at least 15 minutes. Results Fluorescent lymph nodes were observed only in the patient group with cystoscopic injection of ICG:HSA. Filling of the bladder post-injection was of added value to promote drainage of ICG:HSA to the lymph nodes, and in 11 of these 12 patients (92%) one or more NIR fluorescent lymph nodes were identified. Conclusions The current study demonstrates proof-of-principle of using NIR fluorescence imaging for SLN identification in bladder cancer. Cystoscopic injection with distension of the bladder appears optimal for SLN mapping.

A practical guide for the use of indocyanine green and methylene blue in fluorescence‐guided abdominal surgery

“…Moreover, there is a great inter‐patient variability in lymph drainage patterns, which makes the location of the SLN unpredictable. Recently, NIR fluorescence imaging using ICG could detect a sentinel lymph node in at least 90%, which indicated that this technique could contribute to improved intraoperative staging of bladder cancer …”

“…Sentinel lymph node mapping using ICG has been evaluated for several applications in abdominal surgery (gastroenterology, urology, and gynecology) with different imaging systems . In these studies a high diversity in doses has been used, varying from 100 μg to 25 mg.…”

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update

“…79 Schaafsma et al compared ICG conjugated with albumin (ICG:HSA) with ICG in 24 vulvar cancer patients; HSA was expected to enhance detection because of increased lymphatic uptake. [80][81][82] All 35 nodes were identified in both groups and ICG:HSA did not appear to confer an advantage over ICG alone.…”

Sentinel Lymph Nodes in Endometrial Cancer

“…1) выбор оптимального препарата, 2) выбор места введения, 3) что делать дальше с больными с положительными СЛУ. В настоящее время целый ряд исследований, посвященных СЛУ в онкогинекологии, сфокусирован на изучении ИЦЗ, зарекомендовавшего себя большей частотой выживания, относительной дешевизной, меньшей частотой побочных эффектов, токсичности и аллергических реакций [13,14].…”