Journal
JOURNAL OF SURGICAL ONCOLOGY
Volume 110, Issue 7, Pages 845-850Publisher
WILEY-BLACKWELL
DOI: 10.1002/jso.23740
Keywords
Bladder Cancer; Image-Guided Surgery; Indocyanine Green; Fluorescence Imaging; Sentinel Lymph Node
Funding
- NIH [R01-CA-115296, R21-CA-130297]
- Dutch Cancer Society [UL2010-4732]
- CTMM, the Centre for Translational Molecular Medicine, project MUSIS [03O-202]
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Background and objectivesUnlike other cancers, the Sentinel Lymph Node (SLN) procedure in bladder cancer requires special attention to the injection technique. The aim of this study was to assess feasibility and to optimize tracer injection technique for SLN mapping in bladder cancer patients using NIR fluorescence imaging. MethodsTwenty patients with invasive bladder cancer scheduled for radical cystectomy were prospectively enrolled. Indocyanine green (ICG) bound to human serum albumin (complex ICG:HSA; 500 mu M) was injected peritumourally to permit SLN mapping. ICG:HSA was first administrated serosally (n=5), and subsequently mucosally by cystoscopic injection (n=15). In the last cohort of 12 patients treated with cystoscopic injection, the bladder was kept filled with saline for at least 15min. ResultsFluorescent lymph nodes were observed only in the patient group with cystoscopic injection of ICG:HSA. Filling of the bladder post-injection was of added value to promote drainage of ICG:HSA to the lymph nodes, and in 11 of these 12 patients (92%) one or more NIR fluorescent lymph nodes were identified. ConclusionsThe current study demonstrates proof-of-principle of using NIR fluorescence imaging for SLN identification in bladder cancer. Cystoscopic injection with distension of the bladder appears optimal for SLN mapping. J. Surg. Oncol. 2014 110:845-850. (c) 2014 Wiley Periodicals, Inc.
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