Attention: This page describes uses that are not yet FDA cleared.


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.

sentinel lymph node mapping 

Color image

A representation of what the surgeon can see with the naked eye during the procedure.

Overlay image

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.

Fluorescence image

QUEST SPECTRUM 3.0 Smart Sensors™ provide a wider range of ICG intensity allowing for a deeper, more accurate clinical assessment.

 

Links to supporting literature:

Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery – A Critical Evaluation of Options

 

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).

 

  

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:

Sentinel Lymph Nodes Mapping in Cervical Cancer a Comprehensive Review

Yasser Diab

International Journal of Gynecological Cancer. 2017; 27(1):154-158.

 

 

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