Preclinical feasibility of bronchoscopic fluorescence-guided lung sentinel lymph node mapping
Preclinical feasibility of bronchoscopic fluorescence-guided lung sentinel lymph node mapping
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DOI：
10.1016/j.jtcvs.2022.08.031
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发表时间：
2022-12-13
影响因子：
6
通讯作者：
Yasufuku，Kazuhiro
中科院分区：
文献类型：
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作者：
Gregor，Alexander;Sata，Yuki;Yasufuku，Kazuhiro
目的肺前哨淋巴结标测是通过淋巴管追踪瘤周注射物质，目的是寻找第一个潜在的淋巴结转移部位。我们试图评估支气管镜下荧光引导的前哨淋巴结标测的临床前的可行性。方法选用健康的约克夏猪，用吲哚青绿进行前哨淋巴结标测。主要的荧光成像方法是放置在支气管镜工作通道内的超薄复合纤维内窥镜。二次方法使用放置在气管(刚性支气管镜)和气管前筋膜平面(纵隔镜)的荧光胸腔镜来验证用于前哨淋巴结检测的超薄复合纤维内窥镜设置。做了气管切开术，猪被放置在卧位的外侧。经纤维支气管镜下实质内注射吲哚青绿主要在右下叶进行。超薄复合纤维支气管镜和硬质纤维支气管镜检查分别使用(n=6)和(n=2)纵隔镜检查，前一组引导剂量和超细复合纤维支气管镜优化。在超细复合纤维支气管镜引导下经支气管针吸活检前，用纤维支气管镜探查荧光靶点。标本荧光在进行细胞学涂片之前被记录在案。结果100g/mL10 mg/mL吲哚青绿的μL产生较强的经支气管荧光，且吲哚青绿污染风险低。注射后10分钟即可检测到荧光。超细复合纤维支气管镜、硬质支气管镜和纵隔镜检查具有一致性。除1只猪有呼吸道污染外，超薄复合纤维支气管镜引导下经纤维支气管镜下经纤维支气管针吸活检均获得荧光物质。标本荧光与标本充分性有关。结论支气管镜下荧光引导的前哨淋巴结标测是可行的，标本荧光可实时反馈前哨淋巴结活检成功与否。如果转化为临床实践，必须注意将吲哚青绿渗漏降至最低。
ObjectiveLung sentinel lymph node mapping, where peritumorally injected material is tracked through the lymphatics, aims to find the first potential sites of nodal metastasis. We sought to evaluate the preclinical feasibility of bronchoscopic fluorescence-guided sentinel lymph node mapping.MethodsHealthy Yorkshire pigs were used; sentinel lymph node mapping was performed with indocyanine green. The primary fluorescence imaging method was an ultrathin composite fiberscope placed in the bronchoscope working channel. Secondary methods used a fluorescence thoracoscope placed in the trachea (rigid bronchoscopy) and pretracheal fascial plane (mediastinoscopy) to validate ultrathin composite fiberscope settings for sentinel lymph node detection. A tracheostomy was created, and the pig was placed in a lateral decubitus position. Transbronchial intraparenchymal indocyanine green injection was performed primarily in the right lower lobe. Ultrathin composite fiberscope and rigid bronchoscopy were performed with (n = 6) or without (n = 2) mediastinoscopy, with the former group guiding dose and ultrathin composite fiberscope optimization. Fluorescent targets were interrogated by endobronchial ultrasound before ultrathin composite fiberscope–guided transbronchial needle aspiration. Specimen fluorescence was documented before creating cytological smears. Pigs were killed postprocedure for nodal dissection.ResultsA total of 100 μL of 10 mg/mL indocyanine green generated strong transbronchial fluorescence with low risk of indocyanine green contamination. Fluorescence was detectable by 10 minutes postinjection. There was concordance among ultrathin composite fiberscope, rigid bronchoscopy, and mediastinoscopy. Except for 1 pig with airway contamination, ultrathin composite fiberscope–guided endobronchial ultrasound transbronchial needle aspiration obtained fluorescent material in all pigs. Specimen fluorescence was associated with specimen adequacy.ConclusionsBronchoscopic fluorescence-guided sentinel lymph node mapping was feasible, with specimen fluorescence providing real-time feedback on sentinel lymph node biopsy success. If translated to clinical practice, attention must be paid to minimizing indocyanine green leakage.