Intraoperative sentinel lymph node mapping of the lung using near-infrared fluorescent quantum dots
Intraoperative sentinel lymph node mapping of the lung using near-infrared fluorescent quantum dots
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DOI：
10.1016/j.athoracsur.2004.06.055
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发表时间：
2005-01-01
影响因子：
4.6
通讯作者：
Mihaljevic, T
中科院分区：
文献类型：
--
作者：
Soltesz, EG;Kim, S;Mihaljevic, T
背景资料。淋巴结转移是判断非小细胞肺癌(NSCLC)预后的重要指标。评估前哨淋巴结(SLN)是否存在肿瘤可能会改善分期。我们的目标是开发一种光学非侵入性成像工具，允许术中定位SLN，并为图像引导的定位和切除提供实时视觉反馈。不可见的近红外(NIR)光穿透组织相对较深，背景自体荧光较低。我们开发了一种近红外荧光成像系统，可以同时显示手术野的彩色视频和近红外图像。我们最近设计出了15 nm非放射性近红外荧光量子点(QD)，作为最佳的淋巴营养光学探针。将这些量子点引入肺组织，可以实时显示引流的淋巴通道和结节。在12头约克夏猪(平均体重35公斤)上，我们证明了向肺叶实质注射200pmoL近红外量子点准确地映射了淋巴引流和SLN。所有SLN都是强荧光的，注射后5分钟内很容易被观察到。在14次单独注射中，量子点定位于纵隔结节，而在2次注射中，量子点定位于肺门实质内结节。所有病例的组织学分析均证实存在结节组织。我们报告了一种用于肺SLN标测的高灵敏快速技术。该技术允许精确的实时成像，因此克服了当前可用技术的许多限制。
Background. The presence of lymph node metastases is an important prognostic marker with regard to non-small-cell lung cancer (NSCLC). Assessment of the sentinel lymph node (SLN) for the presence of tumor may improve staging. Our objective was to develop an optical noninvasive imaging tool that would permit intraoperative SLN mapping and provide real-time visual feedback for image-guided localization and resection.Methods. Invisible near-infrared (NIR) light penetrates relatively deeply into tissue and background autofluorescence is low. We have developed a NIR fluorescence imaging system that simultaneously displays color video and NIR images of the surgical field. We recently engineered 15 nm nonradioactive NIR fluorescent quantum dots (QDs) as optimal lymphotrophic optical probes. The introduction of these QDs into lung tissue allows real-time visualization of draining lymphatic channels and nodes.Results. In 12 Yorkshire pigs (mean weight 35 kg) we demonstrated that 200 pmol of NIR QDs injected into lobar parenchyma accurately maps lymphatic drainage and the SLN. All SLNs were strongly fluorescent and easily visualized within 5 minutes of injection. In 14 separate injections QDs localized to a mediastinal node, whereas in 2 injections QDs localized to a hilar intraparenchymal node. Histologic analysis in all cases confirmed the presence of nodal tissue.Conclusions. We report a highly sensitive rapid technique for SLN mapping of the lung. This technique permits precise real-time imaging and therefore overcomes many limitations of currently available techniques.