Annals of Surgical Oncology

, Volume 13, Issue 3, pp 386–396 | Cite as

Sentinel Lymph Node Mapping of the Gastrointestinal Tract by Using Invisible Light

  • Edward G. Soltesz
  • Sungjee Kim
  • Sang-Wook Kim
  • Rita G. Laurence
  • Alec M. De Grand
  • Cherie P. Parungo
  • Lawrence H. Cohn
  • Moungi G. Bawendi
  • John V. Frangioni
Original Article

Abstract

Background

Because many gastrointestinal (GI) tumors spread by way of lymphatics, histological assessment of the first draining lymph nodes has both prognostic and therapeutic significance. However, sentinel lymph node mapping of the GI tract by using available techniques is limited by unpredictable drainage patterns, high background signal, and the inability to image lymphatic tracers relative to surgical anatomy in real time. Our goal was to develop a method for patient-specific intraoperative sentinel lymph node mapping of the GI tract by using invisible near-infrared light.

Methods

We developed an intraoperative near-infrared fluorescence imaging system that simultaneously displays surgical anatomy and otherwise invisible near-infrared fluorescence images of the surgical field. Near-infrared fluorescent quantum dots were injected intraparenchymally into the stomach, small bowel, and colon, and draining lymphatic channels and sentinel lymph nodes were visualized. Dissection was performed under real-time image guidance.

Results

In 10 adult pigs, we demonstrated that 200 pmol of quantum dots quickly and accurately map lymphatic drainage and sentinel lymph nodes. Injection into the mid jejunum and colon results in fluorescence of a single lymph node at the root of the bowel mesentery. Injection into the stomach resulted in identification of a retrogastric node. Histological analysis in all cases confirmed the presence of nodal tissue.

Conclusions

We report the use of invisible near-infrared light for intraoperative sentinel lymph node mapping of the GI tract. This technology overcomes the limitations of currently available methods, permits patient-specific imaging of lymphatic flow and sentinel nodes, and provides highly sensitive, real-time image-guided dissection.

Keywords

Sentinel lymph node mapping GI tumors Near-infrared light Quantum dots 

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Copyright information

© The Society of Surgical Oncology, Inc. 2006

Authors and Affiliations

  • Edward G. Soltesz
    • 1
  • Sungjee Kim
    • 2
  • Sang-Wook Kim
    • 2
  • Rita G. Laurence
    • 1
  • Alec M. De Grand
    • 3
  • Cherie P. Parungo
    • 1
  • Lawrence H. Cohn
    • 1
  • Moungi G. Bawendi
    • 4
  • John V. Frangioni
    • 3
    • 4
  1. 1.Department of SurgeryBrigham and Women’s HospitalBoston
  2. 2.Department of ChemistryMassachusetts Institute of TechnologyCambridge
  3. 3.Department of Medicine, Division of Hematology/OncologyBeth Israel Deaconess Medical CenterBoston
  4. 4.Department of RadiologyBeth Israel Deaconess Medical CenterBoston

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