Minimally Invasive Electro-Magnetic Navigational Bronchoscopy-Integrated Near-Infrared-Guided Sentinel Lymph Node Mapping in the Porcine Lung

被引：9

作者：

Wada, Hironobu ^{[1
,4
]}

Hirohashi, Kentaro ^{[1
]}

Anayama, Takashi ^{[1
]}

Nakajima, Takahiro ^{[1
,4
]}

Kato, Tatsuya ^{[1
]}

Chan, Harley H. L. ^{[2
]}

Qiu, Jimmy ^{[2
]}

Daly, Michael ^{[2
]}

Weersink, Robert ^{[2
]}

Jaffray, David A. ^{[2
]}

Irish, Jonathan C. ^{[2
,3
]}

Waddell, Thomas K. ^{[1
]}

Keshavjee, Shaf ^{[1
]}

Yoshino, Ichiro ^{[4
]}

Yasufuku, Kazuhiro ^{[1
,2
]}

机构：

[1] Univ Hlth Network, Toronto Gen Hosp, Div Thorac Surg, Toronto, ON, Canada

[2] Univ Hlth Network, TECHNA Inst, Guided Therapeut, Toronto, ON, Canada

[3] Univ Toronto, Princess Margaret Hosp, Univ Hlth Network, Dept Otolaryngol Head & Neck Surg Surg Oncol, Toronto, ON, Canada

[4] Chiba Univ, Grad Sch Med, Dept Gen Thorac Surg, Chiba, Japan

来源：

PLOS ONE | 2015年 / 10卷 / 05期

关键词：

INDOCYANINE GREEN; DOSE-ESCALATION; NECK-CANCER; HEAD; SEGMENTECTOMY; METASTASIS; INJECTION; LOBECTOMY; TRIAL;

D O I：

10.1371/journal.pone.0126945

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background The use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) for sentinel lymph node (SN) mapping has been investigated in lung cancer; however, this has not been fully adapted for minimally invasive surgery (MIS). The aim of our study was to develop a minimally invasive SN mapping integrating pre-operative electro-magnetic navigational bronchoscopy (ENB)-guided transbronchial ICG injection and intraoperative NIR thoracoscopic imaging. Methods A NIR thoracoscope was used to visualize ICG fluorescence. ICG solutions in a 96-well plate and ex vivo porcine lungs were examined to optimize ICG concentrations and injection volumes. Transbronchial ICG injection (n=4) was assessed in comparison to a traditional transpleural approach (n=3), where after thoracotomy an ICG solution (100 mu L at 100 mu g/mL) was injected into the porcine right upper lobe for SN identification. For further translation into clinical use, transbronchial ICG injection prior to thoracotomy followed by NIR thoracoscopic imaging was validated (n=3). ENB was used for accurate targeting in two pigs with a pseudo-tumor. Results The ICG fluorescence at 10 mu g/mL was the brightest among various concentrations, unchanged by the distance between the thoracoscope and ICG solutions. Injected ICG of no more than 500 mu L showed a localized fluorescence area. All 7 pigs showed a bright paratracheal lymph node within 15 minutes post-injection, with persistent fluorescence for 60 minutes. The antecedent transbronchial ICG injection succeeded in SN identification in all 3 cases at the first thoracoscopic inspection within 20 minutes post-injection. The ENB system allowed accurate ICG injection surrounding the pseudo-tumors. Conclusions ENB-guided ICG injection followed by NIR thoracoscopy was technically feasible for SN mapping in the porcine lung. This promising platform may be translated into human clinical trials and is suited for MIS.

引用

页数：13

共 29 条

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