Time-lapse imaging of sentinel lymph node using indocyanine green with near-infrared fluorescence imaging in early endometrial cancer

다국어 초록 (Multilingual Abstract)

Objective: Indocyanine green with near-infrared fluorescence imaging (NIR-ICG) is a newtracer modality in the limelight used for lymphatic mapping. The advantage of this methodis to provide real-time image during surgery. To use ICG for image guided lymph nodedissection, a surgeon needs to know initial appearing time and duration.
Methods: A 52-year-old woman undertook surgery diagnosed with endometrial cancer. Shehad no past medical history and her body mass index was 25.3 kg/m2. Preoperative magneticresonance imaging examination revealed 2.7 cm sized cancerous mass in the endometrialcavity 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 wasinjected superficially, 2–3 mm into the cervical submucosa and another 1 mL was injecteddeep, 1–2 cm into the stroma of the cervix [1,2]. We recorded video with 30° 10 mm scopeequipped with a specific lens and light source emitting both visible and NIR light (KARLSTORZ GmbH & Co. KG, Tuttlingen, Germany).
Results: Pelvic lymph node was visualized from around 5 minutes. ICG was dispersed intoorgans after hysterectomy (53 minutes after ICG injection), yet we could clearly identifysentinel lymph node (SLN). Pathology revealed endometriod adenocarcinoma grade I,myometrial invasion with less than half of myometrium and no lymph node metastasis.
Conclusion: Cervical injection of ICG provides good visualization of SLN from 5 minutes toover an hour. Our film gives an idea about time management to make a plan for surgery andnot to miss SNLs.

참고문헌 (Reference)

1 Abu-Rustum NR, "Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma?" 113 : 163-169, 2009

2 How J, "Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer" 137 : 436-442, 2015