Attention: This page describes uses that are not yet FDA approved.
To determine the staging of various types of cancer, assessment of metastases is vital. Identification of the sentinel lymph node (SLN), is a critical part of this assessment. Detection of the SLN can be greatly improved using fluorescence imaging. In this procedure a fluorescent tracer, Indocyanine Green (ICG), is injected in the tumor region. ICG flows through the lymphatic system to the connecting lymph nodes.
Using the Quest Spectrum® in conjunction with ICG allows for the mapping of the tumor drainage lymphatic system, including nodes and veins. The SLN detected using the Quest Spectrum in combination with ICG can be biopsied for cancer staging. An example of the performance of the Quest Spectrum in sentinel lymph node mapping is shown here.
A representation of what the surgeon can see with the naked eye during the procedure.
A combination of the color and the fluorescent signal (the green color) is provided to the surgeon for optimal guidance and detection of the lymph node during the surgery.
A representation of the intensity of the fluorescence signal created by the ICG that has localized to the lymph node.
Near-infrared fluorescent imaging identifies significantly more and smaller tumors during resection of colorectal cancer liver metastasis, preventing recurrences in a subset of patients. Given its safety profile and low expense, use of ICG can be considered until tumor targeting fluorescent tracers are clinically available.
Sentinel lymph node mapping (SLNM) in breast tissue using ICG
The video below shows the application of the Quest Spectrum® for the detection of the sentinel lymph node (SLN). In this procedure a SLN is detected in an open surgery using ICG as a fluorescent marker. ICG accumulates in the SLN and assists in the detection and excision of the lymph node in breast tissue.
To determine the staging in breast cancer, assessment of metastases to the sentinel lymph node (SLN) is vital.
The gold standard for the detection of the SLN involves the application of Technetium, a radioisotope with a high SLN detection rate. Unfortunately, Technetium does not allow intraoperative visualization. It is therefore combined with Patent Blue, a staining agent with a low detection rate and known to color the breast blue for a considerable time (tattooing).
To overcome the limitations of current tracers in the SNL gesture, an increasing number of hospitals are evaluating green indocyanine (ICG).
Links to supporting literature:
Hackethal et al.
Geburtshilfe und Frauenheilkunde. 2018; 78(1):54-62
Samorani et al.,
European Journal of Surgical Oncology (EJSO) 2015 vol: 41 (1) pp: 64-70
Cattin et al.
Journal of Cancer Science & Therapy 2017 vol: 09 (02)
Verbeek et al.
Breast Cancer Research and Treatment 2014 vol: 143 (2) pp: 333-342
van der Vorst et al.
Annals of surgical oncology 2012 vol: 19 (13) pp: 4104-11
Graham S. Schwarz et al.
Journal of Surgical Oncology, Wiley, 2-19, pp: 160-167
Sentinel lymph node mapping (SLNM) in cases of endometrial cancer using ICG
The video below shows the application of the Quest Spectrum® for the detection of the SLN. In this procedure a sentinel lymph node (SLN) is detected in a laparoscopic surgery using ICG as a fluorescent marker. ICG accumulates in the SLN and assists in the detection and excision of the lymph node.
Sentinel lymph node mapping using ICG has been shown to be effective in cervical cancer patients with excellent detection rates and high sensitivity.
The referenced articles propose that a routine clinical evaluation of sentinel lymph nodes is feasible. Real-time mapping with ICG has demonstrated statistically superior overall and bilateral detection than methylene blue.
Links to supporting literature:
International Journal of Gynecological Cancer. 2017; 27(1):154-158.