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.

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

A representation of the intensity of the fluorescence signal created by the ICG that has localized to the lymph node.

 

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

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:

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

Hackethal et al.

Geburtshilfe und Frauenheilkunde. 2018; 78(1):54-62


The use of indocyanine green to detect sentinel nodes in breast cancer: A prospective study

Samorani et al.,

European Journal of Surgical Oncology (EJSO) 2015 vol: 41 (1) pp: 64-70


Icg Versus 99tc in Breast Surgery-How to Match Quality Health Care and Costs Reduction: A Cost Effectiveness Study

Cattin et al.

Journal of Cancer Science & Therapy 2017 vol: 09 (02)


Near-infrared fluorescence sentinel lymph node mapping in breast cancer: a multicenter experience

Verbeek et al.

Breast Cancer Research and Treatment 2014 vol: 143 (2) pp: 333-342


Randomized comparison of near-infrared fluorescence imaging using indocyanine green and 99(m) technetium with or without patent blue for the sentinel lymph node procedure in breast cancer patients

van der Vorst et al.

Annals of surgical oncology 2012 vol: 19 (13) pp: 4104-11

 

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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