Sentinel Lymph Node Mapping of Liver.
Sentinel Lymph Node Mapping of Liver.
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DOI：
10.1245/s10434-015-4601-5
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发表时间：
2015-12
影响因子：
3.7
通讯作者：
Choi HS
中科院分区：
文献类型：
--
作者：
Wada H;Hyun H;Vargas C;Genega EM;Gravier J;Gioux S;Frangioni JV;Choi HS
虽然前哨淋巴结（SLN）假说已被应用于许多组织和器官，肝脏一直没有研究。目前，还不清楚肝脏SLN是否存在。如果是这样的话，他们可以通过最小化手术范围来改变肝内胆管癌和其他肝脏恶性肿瘤的治疗，同时仍然提供精确的淋巴结分期。我们研究了不可见但可穿透组织的近红外（NIR）荧光是否可以同时识别肝脏中的前哨淋巴结（SLN）和所有其他区域淋巴结（RLN）。在25头约克郡猪中，我们确定了SLN是否存在于肝脏中，并比较了两种临床可用的近红外荧光团，亚甲蓝（MB）和吲哚菁绿色（ICG），以及我们小组先前描述的两种新的近红外荧光团，ESNF 14和ZW 800 -3C，用于SLN和RLN绘图的有效性。ESNF 14在前哨淋巴结中显示最高的信号背景比（SBR）和最长的保留时间，没有泄漏到第二层淋巴结。ICG向第二层淋巴结有明显渗漏，而ZW 800 -3C在实质内注射后迁移较差。然而，当静脉注射时，ZW 800 -3C能够在4-6小时内突出显示肝脏中的所有RLN。SLN（ESNF 14）和RLN（ZW 800 -3C）的同时双通道成像允许明确识别和图像引导切除肝脏中的SLN和RLN。近红外成像技术能够在术中实时识别猪肝脏中的SLN和RLN。如果这些结果在患者中得到证实，肝内恶性肿瘤外科治疗的新策略应该是可能的。
Although the sentinel lymph nodes (SLN) hypothesis has been applied to many tissues and organs, liver has remained unstudied. At present, it is unclear whether hepatic SLNs even exist. If so, they could alter management in intrahepatic cholangiocarcinoma and other hepatic malignancies by minimizing the extent of surgery while still providing precise nodal staging. We investigated whether invisible yet tissue-penetrating near-infrared (NIR) fluorescent light can provide simultaneous identification of both the sentinel lymph node (SLN) and all other regional lymph nodes (RLN) in the liver. In twenty five Yorkshire pigs, we determined whether SLNs exist in liver, and compared the effectiveness of two clinically available NIR fluorophores, methylene blue (MB) and indocyanine green (ICG), and two novel NIR fluorophores previously described by our group, ESNF14 and ZW800-3C, for SLN and RLN mapping. ESNF14 showed the highest signal-to-background ratio (SBR) and longest retention time in SLNs, without leakage to second-tier lymph nodes. ICG had apparent leakage to second-tier nodes, while ZW800-3C suffered from poor migration after intraparenchymal injection. However, when injected intravenously, ZW800-3C was able to highlight all RLNs in liver over a 4–6 h period. Simultaneous dual channel imaging of SLN (ESNF14) and RLN (ZW800-3C) permitted unambiguous identification and image-guided resection of SLNs and RLNs in liver. The NIR imaging technology enables real-time intraoperative identification of SLNs and RLNs in the liver of swine. If these results are confirmed in patients, new strategies for the surgical management of intrahepatic malignancies should be possible.