Theranostics 2014; 4(7):693-700. doi:10.7150/thno.8721

Research Paper

Simultaneous Mapping of Pan and Sentinel Lymph Nodes for Real-Time Image-Guided Surgery

Yoshitomo Ashitate1,2*, Hoon Hyun1*, Soon Hee Kim1, Jeong Heon Lee1, Maged Henary3, John V. Frangioni1,4, Hak Soo Choi1,5✉

1. Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
2. Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
3. Department of Chemistry, Georgia State University, Atlanta, GA 30303, USA
4. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
5. Department of Cogno-Mechatronics Engineering, Pusan National University, Busan 609-735, South Korea
* These authors contributed equally to this work.

Abstract

The resection of regional lymph nodes in the basin of a primary tumor is of paramount importance in surgical oncology. Although sentinel lymph node mapping is now the standard of care in breast cancer and melanoma, over 20% of patients require a completion lymphadenectomy. Yet, there is currently no technology available that can image all lymph nodes in the body in real time, or assess both the sentinel node and all nodes simultaneously. In this study, we report an optical fluorescence technology that is capable of simultaneous mapping of pan lymph nodes (PLNs) and sentinel lymph nodes (SLNs) in the same subject. We developed near-infrared fluorophores, which have fluorescence emission maxima either at 700 nm or at 800 nm. One was injected intravenously for identification of all regional lymph nodes in a basin, and the other was injected locally for identification of the SLN. Using the dual-channel FLARE intraoperative imaging system, we could identify and resect all PLNs and SLNs simultaneously. The technology we describe enables simultaneous, real-time visualization of both PLNs and SLNs in the same subject.

Keywords: Near-infrared fluorescence, pan lymph node mapping, completion lymphadenectomy, sentinel lymph node mapping, image-guided surgery, cervical cancer.

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How to cite this article:
Ashitate Y, Hyun H, Kim SH, Lee JH, Henary M, Frangioni JV, Choi HS. Simultaneous Mapping of Pan and Sentinel Lymph Nodes for Real-Time Image-Guided Surgery. Theranostics 2014; 4(7):693-700. doi:10.7150/thno.8721. Available from http://www.thno.org/v04p0693.htm