Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non–small cell lung cancer.

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Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non–small cell lung cancer using near- infrared imaging Denis M. Gilmore, MD, Onkar V. Khullar, MD, Michael T. Jaklitsch, MD, Lucian R. Chirieac, MD, John V. Frangioni, MD, PhD, Yolonda L. Colson, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 146, Issue 3, Pages 562-570 (September 2013) DOI: 10.1016/j.jtcvs.2013.04.010 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Sentinal lymph node (SLN) identification. A dose-dependent increase in SLN identification is demonstrated as a function of indocyanine green (ICG) dose from 3.8 to 2500 μg. The SLN identification rate was 100% in the highest cohort. RUL, Right upper lobe; RML, right middle lobe; RLL, right lower lobe; LUL, left upper lobe; LLL, left lower lobe. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 562-570DOI: (10.1016/j.jtcvs.2013.04.010) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative real-time identification of sentinel lymph nodes (SLNs) using near-infrared (NIR) fluorescent imaging. A, The lymphatic migration of indocyanine green is noted in green and progresses from the site of injection toward the hilum (arrow). B, The SLN is identified using NIR fluorescent imaging and is shown in green (arrow). The Journal of Thoracic and Cardiovascular Surgery 2013 146, 562-570DOI: (10.1016/j.jtcvs.2013.04.010) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Ex vivo sentinel lymph node (SLN) imaging using near-infrared (NIR) fluorescent imaging. After intraoperative identification and excision of the SLN, the SLN is imaged ex vivo using NIR imaging to confirm fluorescence. A, White light image of the SLN. B, Pure NIR image demonstrating NIR fluorescence in white (arrowhead). C, Merged pseudocolored image of the SLN with NIR fluorescence within the SLN shown in green. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 562-570DOI: (10.1016/j.jtcvs.2013.04.010) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Lymphatic map of sentinel lymph node (SLN) stations identified via near-infrared (NIR) image guidance: a total of 26 NIR+ SLNs were identified in 15 patients. The location of the identified SLNs in relation to the site of the primary tumor (and injection site) is demonstrated. RUL, Right upper lobe; LUL, left upper lobe; RML, right middle lobe; LLL, left lower lobe; RLL, right lower lobe; L, left; R, right. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 562-570DOI: (10.1016/j.jtcvs.2013.04.010) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions