Multispectral gynecologic कैंसर विज्ञान में प्रहरी लिम्फ नोड के Intraoperative पता लगाने के लिए वास्तविक समय प्रतिदीप्ति इमेजिंग
Summary
प्रतिदीप्ति इमेजिंग छवि निर्देशित शल्य चिकित्सा के लिए शल्य चिकित्सा ऑन्कोलॉजी में एक होनहार अभिनव साधन है. इस वीडियो में हम प्रहरी लिम्फ नोड प्रतिदीप्ति इमेजिंग का उपयोग कर के रूप में gynecologic oncologicy में प्रदर्शन का पता लगाने के के लिए तकनीकी प्रक्रिया का वर्णन. एक multispectral प्रतिदीप्ति कैमरा प्रणाली, फ्लोरोसेंट एजेंट के साथ मिलकर हरी indocyanine लागू है.
Abstract
The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.
Protocol
Discussion
यह वीडियो gynecologic ऑन्कोलॉजी में प्रहरी लिम्फ नोड (SLN) intraoperative पता लगाने के लिए multispectral intraoperative प्रतिदीप्ति इमेजिंग प्रौद्योगिकी के अनुप्रयोग को दर्शाता है. पद्धति पारंपरिक SLN प्रक्रिया पर कुछ फायदे हैं. इंजेक्शन विशेष रूप से gynecologic कैंसर में शल्य चिकित्सा की प्रक्रिया ही सर्जरी से पहले एक दिन, जो अधिक रोगी के अनुकूल बजाय anesthetized रोगी के साथ के दौरान जगह लेता है. इसके अलावा, intraoperative इमेजिंग लसीका प्रवाह और उसके जल निकासी पैटर्न SLN करने के लिए, बजाय एक Geiger-टेलर के माध्यम से परोक्ष रूप से प्रत्यक्ष दृश्य प्रतिक्रिया के साथ सर्जन प्रदान करता है. गर्भाशय ग्रीवा के कैंसर में, जहां लिम्फ नोड्स गहरी श्रोणि में स्थित हैं, यह पता लगाने में सुधार मदद मिल सकती है.
बहरहाल, सबसे बड़ा महत्व लक्षित इमेजिंग की दिशा में कदम दृष्टिकोण में निहित है. लक्षित फ्लोरोसेंट विपरीत एजेंटों ट्यूमर विशिष्ट एंटीबॉडी या substrates विशेष रूप से ट्यूमर कोशिकाओं को निर्देशित के साथ जुड़े हुए हो सकता है. इस तरीके में, intraoperative प्रतिदीप्ति इमेजिंग महान मौलिक Oncologic सर्जरी की वर्तमान अभ्यास को बदलने की क्षमता है.
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
हम या कर्मियों के प्रशिक्षण और नियोजन के लिए श्रीमती इना Wesselman ऋणी हैं.
Materials
| Material Name | Tipo | Company | Catalogue Number | Comment |
|---|---|---|---|---|
| Indocyanine Green (ICG) | Pulsion Medical Systems AG, Munich, Germany | D-81829 | A solution of ICG in distilled water is used and not in NaCl 0.9%. | |
| Patent blue / Bleu patenté | Guerbet, Paris, France | 12322784 | ||
| Sterile water for injection | B. Braun | |||
| Multispectral fluorescence camera system | Institute for Biological and Medical Imaging (IBMI), Technical University, Munich, Germany and SurgOptix Inc, USA | prototype |
Riferimenti
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