Endoscopic Detection of Fluorescein for Sentinel Lymph Node Biopsy

描述（由申请人提供）：本资助的目的是开发荧光内窥镜仪器，以促进乳腺癌的手术治疗，并可能应用于其他类型的癌症。该项目的具体目标是为目前可用的外科望远镜开发一种组合全息陷波滤波器适配器和可切换的高强度LED光源适配器。这种新设备将允许外科医生用微创手术技术对乳腺癌患者进行腋窝淋巴结清扫。这种新设备将是一种更有效、更准确、更经济、更安全的方法，用于对乳腺癌患者的淋巴结簇进行前哨淋巴结清扫。荧光淋巴测图剂的照明与适当匹配的荧光光源将更有效的红移红光和近红外荧光是可见的，通过许多层的组织。这可以减少手术室时间，并避免目前使用的可见染料标记（淋巴管蛋白(r)）需要进行完整的腋窝解剖。这种装置将比用于寻找放射性标记物（锝硫胶体）的伽马射线探测器更精确。荧光内窥镜检查每个病人的费用更低，因为它取代了两种显像剂药物（其中一种是放射性的）。Vestan将生产几种原型全息光学滤光片和可切换的高强度LED光源，这些光源与FDA批准的荧光药物荧光素相匹配。光学陷波滤光片将直接连接到目前使用的外科望远镜上，以方便操作人员。所有外科医生都可以使用荧光素，目前用于测定术中肠道活力。维斯坦将在猪淋巴测绘模型中演示该装置的可行性。荧光素将被注射到成年猪后肢真皮中。荧光内窥镜仪器将用于确定淋巴管和发现前哨淋巴结与微创手术技术。该装置的准确性将根据目前使用的蓝色染料Lymphazurin(r)进行评估。由于每年有20万新的乳腺癌病例发生，并且都需要腋窝淋巴结清扫，这种新方法将使成千上万的妇女受益，用3%英寸的切口代替8英寸的切口。此外，这种用荧光发现前哨淋巴结的新方法避免了使用放射性药物和使用与1%过敏性休克风险相关的染料。

DESCRIPTION (provided by applicant): The objective of this grant is to develop fluorescence endoscopy instrumentation to facilitate the surgical management of breast cancer, with possible application to other types of cancer. The specific aims for this project are to develop a combination holographic notch filter adapter and switchable high-intensity LED light source adapter for currently available surgical telescopes. This new device will allow the surgeon to perform the axillary dissection of lymph nodes in breast cancer patients with minimally-invasive surgical techniques. This new device will be a more efficient, more accurate, more cost-effective and safer way to perform the sentinel lymph node dissection of lymph node clusters in breast cancer patients. Illumination of a fluorescent lymphatic mapping agent with an appropriately matched fluorescent light source will be more efficient as red- shifted red and near-infrared fluorescent light is visible through many layers of tissue. This may reduce operating room time and obviate the need for a complete axillary dissection which is needed with the currently used visible dye marker (Lymphazurin(r). This device will be more accurate than the gamma ray detector used to find the radioactive marker (technetium sulfur colloid). Fluorescence endoscopy will be less-expensive per patient, as it replaces two imaging agent drugs (one of which is radioactive). Vestan will produce several prototype holographic optical notch filters and switchable high-intensity LED light sources that are matched to the FDA- approved fluorescent drug, fluorescein. The optical notch filter will attach directly to currently used surgical telescopes for the convenience of the operators. Fluorescein is available to all surgeons and it is currently used to determine intraoperative bowel viability. Vestan will demonstrate the feasibility of the device in a pig model of lymphatic mapping. Fluorescein will be injected into the dermis of the hind limb of adult pigs. The fluorescence endoscopy instrumentation will be used to define the lymphatic vessels and to find the sentinel lymph node with minimally-invasive surgical techniques. The accuracy of the device will be evaluated against the currently used blue dye, Lymphazurin(r). Since 200,000 new cases of breast cancer occur each year, and all require an axillary lymph node dissection, this new approach will benefit thousands of women, using three % inch incisions to replace an 8 inch incision. In addition, this new method of finding the sentinel lymph node with fluorescence avoids the use of radioactive drugs and the use of a dye that is associated with a 1% risk of anaphylactic shock.