作者没有什么可透露的。

所有程序,包括人类受试者,均获得佛法癌症医院伦理委员会的批准,证书号为040/KEPK/VII/2017。所有患者都签署了同意书,并表示同意参与本研究。
注:纳入标准是早期乳腺癌诊断的患者,肿瘤阶段T1-T2无可触手可及和超声检查淋巴结扩大(cNo)。排除标准是局部晚期乳腺癌,接受新佐剂化疗或激素治疗,和怀孕。
1. 1%亚甲蓝染料的制备及注射技术
<ol><li>麻醉病人后,对手术场进行消毒。</li>
	<li>用3 mL注射器从小瓶中吸出2 mL的1%亚甲基蓝色染料。</li>
	<li>画一条线 , 以标记下部发线以下的胸围主要肌肉的侧界。</li>
	<li>将 2 mL 的 1% 亚甲基蓝色染料注入乳房的亚雷欧尔空间。</li>
	<li>如果乳房或 NAC 的上外象限有疤痕,则用线心针(12 MHz)在超声波指导下用 23G 针向疤痕的侧侧向腹腔内注射 2 mL 的 1% 亚甲蓝色染料。</li>
	<li>在注射部位循环按摩乳房5分钟,然后继续做手术。</li>
</ol>2. 乳房保存手术的哨兵节点活检技术(BCS)
注:手术是在接受BCS和SNB的患者身上进行的。
<ol><li>准备手术工具:单极电烧、德巴基钳子/解剖钳子和缩回器。</li>
	<li>切开皮肤、皮下组织和筋膜。</li>
	<li>找到蓝色结节或蓝色淋巴片。跟随蓝色区域,直到蓝色结点或带淋巴蓝色区域的非蓝色节点可识别。</li>
	<li>如果找不到蓝色结点或蓝色淋巴带,则沿闭周神经和侧胸静脉搜索哨点节点。</li>
	<li>仔细切除哨兵节点,避免损坏节点。</li>
	<li>将心氧化空间,以找到额外的可疑恶性淋巴结增大。</li>
</ol>3. 乳房切除术中的哨兵节点活检技术
注:手术是在接受乳房切除术和SNB的病人身上进行的。
<ol><li>切开皮肤和皮下组织。</li>
	<li>创建皮瓣。</li>
	<li>从胸腔主要去除乳房,直到可充分暴露的阴垂fosa。</li>
	<li>将锁骨筋膜切开以找到哨点节点。</li>
	<li>如果找不到蓝色淋巴带,则沿闭胆神经和侧胸静脉区域找到哨点节点。</li>
	<li>删除哨兵节点。</li>
	<li>通过触觉寻找其他可疑的淋巴结。</li>
</ol>4. 术中检查
<ol><li>切淋巴结不超过2毫米,平行于长轴。</li>
	<li>从每个节点进行触摸印记细胞学。</li>
	<li>将手术标本放在金属组织盘上,嵌入与冷冻组织密度相同的凝胶状介质中。</li>
	<li>提交所有节点进行冻结部分 (FS) 检查。</li>
	<li>将哨点节点的转移状态分类为阳性或阴性,并在手术期间向外科医生报告。</li>
</ol>5. 病理检查
<ol><li>对正式固定和石蜡嵌入组织部分的哨兵节点进行最终病理评估。</li>
	<li>根据美国癌症联合委员会(AJCC)第6版手册对哨点节点转移进行分类。巨转移(MAC)定义为大于2毫米的肿瘤沉积物,微转移(MiC)定义为0.2至2 mm之间的肿瘤沉积,分离肿瘤细胞(ITC)定义为不超过0.2毫米的细胞簇。</li>
	<li>当对ITC的定义有疑问时,对细胞角蛋白进行序列切片和免疫组化学分析。</li>
	<li>以类似的方式检查其他的阳部淋巴结。</li>
</ol>

<ol>
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我们感谢穆罕默德、M.D.阿里·阿卜杜勒·阿齐兹先生、阿迪亚·巴尤先生和阿里安达·哈里阿迪先生协助编写手稿。我们还感谢特加尔·哈里马先生在视频编辑方面提供的帮助。

在现代乳腺癌手术时代,瑞士央行已经取代ALND作为早期乳腺癌的乳腺分期护理标准,如果SN没有转移14,15,ALND应该放弃。发达国家常用的淋巴图谱技术是放射性同位素示踪剂和PBD作为组合或单一技术的应用。当无法获得放射性同位素甚至多溴联苯时,提出了如何执行瑞士国民计划的问题。我们描述的仅使用 MBD 的技...

肛门淋巴结(ALNs)转移状态是乳腺癌最重要的预后因素。Axill淋巴结解剖(ALND)是评估ALN1,2转移状态的常规程序。不幸的是,ALND导致患者的病态,降低生活质量,特别是通过增加淋巴水肿的风险后,这个程序3,4。如今 , 哨点节点活检 ( SNB ) 已经取代 ALND 为分期 , 因为它在患者中最小的疾病 5 。执行SNB的最常见方法是使用放射性同位素示踪剂和PBD6。在世界某些地区,包括发展中国家,这些示踪剂可能难以采购,寻找替代示踪剂对于解决这一问题至关重要。
最初,MBD被 Wong 等人用作映射哨兵节点 (SN)7的跟踪代理。在使用猫科模型的研究中,MBD的皮内注射显示淋巴摄取不良,而异硫丹蓝被选为哨兵节点(SN)映射7的首选染料。自从西蒙斯等人8日首次成功报告以来,甲基蓝染料已用于乳腺癌SNB。一些研究也报告MBD是SN鉴定的有利染料,MBD技术的假阴性率可与放射性同位素或PBD9、10、11相媲美。减少过敏反应和更低的价格是考虑在SN映射12中使用的其他原因。
最近,我们研究了在临床节点阴性乳腺癌中单独使用1%MBD对SNB。在早期阶段,MBD具有有利的识别率和负预测值13。如果我们在乳房的上外象限或奶嘴复合物 (NAC) 处出现外检活检疤痕,我们向下腹空间或腹肌区域注射 2 mL 的 1% MBD。蓝色节点和带淋巴蓝色通道的非蓝色节点被归类为 SN。在斧片的解剖地标被用作寻找SN的指导。 术中检查用于评估转移和SN被发送到组织病理学分析基于美国临床肿瘤学会(ASCO)指南14。
如果仔细选择病例,并且由外科医生和病理学家获得此技术所需的技能,许多患者可以挽救从ALND的有害影响,同时仍然有良好的生存。

<table><tbody><tr><td>Metiblo 50mg/5ml</td><td>Laboratories Sterop NV</td><td>BE475217</td><td>Methylene Blue Dye</td></tr><tr><td>Disposable syringe with needle - 3mL (Luer Lock Tip)</td><td>Terumo Europe NV</td><td>dvr-3414</td><td>Syringe for Injection</td></tr><tr><td>ForceTriad energy platform</td><td>Medtronic</td><td>ForceTriad</td><td>Surgical cautery</td></tr><tr><td>Shandon Cryomatrix embedding resin</td><td>Thermo (scientific)</td><td>6769006</td><td>Frozen Section</td></tr><tr><td>Cryotome FSE</td><td>Thermo (scientific)</td><td>77210153</td><td></td></tr><tr><td>HistoStar Embedding Workstation</td><td>Thermo (scientific)</td><td>A81000001</td><td>Histopathological Examination</td></tr><tr><td>Finesse Me+</td><td>Thermo (scientific)</td><td>A77510272</td><td></td></tr><tr><td>Gemini AS</td><td>Thermo (scientific)</td><td>A81500002</td><td></td></tr><tr><td>Benchmark GX</td><td>Ventana Medical Systems</td><td>750-850</td><td>Immunohistochemistry</td></tr><tr><td>Benchmark XT</td><td>Ventana Medical Systems</td><td>750-700</td><td></td></tr><tr><td>Microscope</td><td>Olympus</td><td>Model BX53</td><td></td></tr><tr><td>Ultrasound</td><td>Phillips</td><td>HD 7XE</td><td></td></tr></tbody></table>

the application of 1% methylene blue dye as a single technique in breast cancer sentinel node biopsy

在这项研究中,我们向乳房的亚耳原或胸周空间注射了1%的亚甲基蓝色染料(MBD)。在吸乳手术(BCS)中,在下部斧头发线中做了一个单独的切口来查找哨点节点(SNs)。在乳房切除术中,SN通过同一乳房切除切口被识别。SN 被描述为蓝色节点或具有淋巴蓝色通道的节点。在斧片的解剖地标被用来促进SN识别。SNs转移是一个黄金标准,通过术中冷冻切片分析和组织病理学检查来评估。在这里,我们描述MBD是乳腺癌哨点节点活检(SNB)中唯一的技术,当无法提供放射性同位素示踪剂或专利或异硫酸盐蓝色染料(PBD)时,该技术可能很有用。

在这里,我们描述从呈现的技术的结果。两毫升1%MBD被注射在深亚罗拉空间作为注射的标准技术(图1A)。如果指示了微体注射,则应在超声波指导下进行(图1B)。进入突经空间后,可以看到蓝色结节或淋巴蓝色区域。继淋巴蓝片后,找到SN(图2A)。如果看不到蓝色结节或淋巴蓝片,我们使用闭周神经和侧胸静脉作为解?...

Watch this Scientific Journal Video about The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy at JoVE.com

The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy

在印度尼西亚,由于提供放射性同位素示踪剂和异硫酸盐或专利蓝色染料(PBD)的限制,乳腺癌手术不定期进行哨点节点活检(SNB)。为了克服这一障碍,我们应用1%亚甲基蓝色染料(MBD)作为单一剂来映射哨兵节点(SNs)。

1%亚甲蓝染料作为单一技术在乳腺癌哨点节点活检中的应用

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery ...

将百分之一甲基蓝染料作为单一技术应用于乳腺癌哨点活检。该程序的总体目标是将蓝色染料单独应用为早期乳腺癌轴结活检的单一技术，使用1%甲基蓝染料，并展示如何对哨点节点进行异硫素检测。第一节制备百分之一的甲苯蓝色染料及注射技术。第二节哨点节点活检技术在乳房保护手术中。第三节。乳腺切除术中的哨点点活检技术。第四节哨点节点病理检查。第五节术内检查。第六节结果。第七节结论。

the-application-1-methylene-blue-dye-as-single-technique-breast

Research

JoVE Journal

Cancer Research

18.9K 次观看.  Dharmais Cancer Hospital. 将百分之一甲基蓝染料作为单一技术应用于乳腺癌哨点活检。该程序的总体目标是将蓝色染料单独应用为早期乳腺癌轴结活检的单一技术，使用1%甲基蓝染料，并展示如何对哨点节点进行异硫素检测。第一节制备百分之一的甲苯蓝色染料及注射技术。第二节哨点节点活检技术在乳房保护手术中。第三节。乳腺切除术中的哨点点活检技术。第四节哨点节点病理检查。?...

视频: The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Fluorescence imaging is a promising innovative modality for image-guided surgery in surgical oncology. In this video we describe the technical procedure for detection of the sentinel lymph node using fluorescence imaging as showcased in gynecologic oncologicy. A multispectral fluorescence camera system, together with the fluorescent agent indocyanine green, is applied.

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

科研

医学

A Portal Vein Injection Model to Study Liver Metastasis of Breast Cancer

Breast cancer is the leading cause of cancer-related mortality in women worldwide. Liver metastasis is involved in upwards of 30% of cases with breast cancer metastasis, and results in poor outcomes with median survival rates of only 4.8 - 15 months. Current rodent models of breast cancer metastasis, including primary tumor cell xenograft and spontaneous tumor models, rarely metastasize to the liver. Intracardiac and intrasplenic injection models do result in liver metastases, however these models can be confounded by concomitant secondary-site metastasis, or by compromised immunity due to removal of the spleen to avoid tumor growth at the injection site. To address the need for improved liver metastasis models, a murine portal vein injection method that delivers tumor cells firstly and directly to the liver was developed. This model delivers tumor cells to the liver without complications of concurrent metastases in other organs or removal of the spleen. The optimized portal vein protocol employs small injection volumes of 5 - 10 &#956;l, &#8805; 32 gauge needles, and hemostatic gauze at the injection site to control for blood loss. The portal vein injection approach in Balb/c female mice using three syngeneic mammary tumor lines of varying metastatic potential was tested; high-metastatic 4T1 cells, moderate-metastatic D2A1 cells, and low-metastatic D2.OR cells. Concentrations of &#8804; 10,000 cells/injection results in a latency of ~ 20 - 40 days for development of liver metastases with the higher metastatic 4T1 and D2A1 lines, and &#62; 55 days for the less aggressive D2.OR line. This model represents an important tool to study breast cancer metastasis to the liver, and may be applicable to other cancers that frequently metastasize to the liver including colorectal and pancreatic adenocarcinomas.

A surgical procedure was developed to deliver mammary tumor cells to the murine liver via portal vein injection. This model permits investigation of late stages of liver metastasis in a fully immune competent host, including tumor cell extravasation, seeding, survival, and metastatic outgrowth in the liver.

门静脉注射模型来研究肝转移乳腺癌

Breast cancer is the leading cause of cancer-related mortality in women worldwide. Liver metastasis is involved in upwards of 30% of cases with breast ...

癌症研究

In Vivo Immunofluorescence Localization for Assessment of Therapeutic and Diagnostic Antibody Biodistribution in Cancer Research

Monoclonal antibodies (mAbs) are important tools in cancer detection, diagnosis, and treatment. They are used to unravel the role of proteins in tumorigenesis, can be directed to cancer biomarkers enabling tumor detection and characterization, and can be used for cancer therapy as mAbs or antibody-drug conjugates to activate immune effector cells, to inhibit signaling pathways, or directly kill cells carrying the specific antigen. Despite clinical advancements in the development and production of novel and highly specific mAbs, diagnostic and therapeutic applications can be impaired by the complexity and heterogeneity of the tumor microenvironment. Thus, for the development of efficient antibody-based therapies and diagnostics, it is crucial to assess the biodistribution and interaction of the antibody-based conjugate with the living tumor microenvironment. Here, we describe In Vivo Immunofluorescence Localization (IVIL) as a new approach to study interactions of antibody-based therapeutics and diagnostics in the in vivo physiological and pathological conditions. In this technique, a therapeutic or diagnostic antigen-specific antibody is intravenously injected in&#160;vivo and localized ex vivo with a secondary antibody in isolated tumors. IVIL, therefore, reflects the in vivo biodistribution of antibody-based drugs and targeting agents. Two IVIL applications are described assessing the biodistribution and accessibility of antibody-based contrast agents for molecular imaging of breast cancer. This protocol will allow future users to adapt the IVIL method for their own antibody-based research applications.

The in vivo immunofluorescence localization (IVIL) method can be used to examine in vivo biodistribution of antibodies and antibody conjugates for oncological purposes in living organisms using a combination of in vivo tumor targeting and ex vivo immunostaining methods.

在Vivo免疫荧光定位中用于评估癌症研究中的治疗和诊断抗体生物分布

Monoclonal antibodies (mAbs) are important tools in cancer detection, diagnosis, and treatment. They are used to unravel the role of proteins in ...

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.

Loss of peritoneal integrity provides a new paradigm to understand and treat chronic pelvic pain in women with mild forms of endometriosis and can be easily detected using intraoperative instillation of dye at the time of laparoscopy.

术中的微妙的子宫内膜异位症的检测：A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的

Endometriosis is a  common disease affecting 40 to 70% of reproductive-aged women with chronic  pelvic pain (CPP) and/or infertility. The purpose of this ...

Using Computer-based Image Analysis to Improve Quantification of Lung Metastasis in the 4T1 Breast Cancer Model

Breast cancer is a devastating malignancy, accounting for 40,000 female deaths and 30% of new female cancer diagnoses in the United States in 2019 alone. The leading cause of breast cancer related deaths is the metastatic burden. Therefore, preclinical models for breast cancer need to analyze metastatic burden to be clinically relevant. The 4T1 breast cancer model provides a spontaneously-metastasizing, quantifiable mouse model for stage IV human breast cancer. However, most 4T1 protocols quantify the metastatic burden by manually counting stained colonies on tissue culture plates. While this is sufficient for tissues with lower metastatic burden, human error in manual counting causes inconsistent and variable results when plates are confluent and difficult to count. This method offers a computer-based solution to human counting error. Here, we evaluate the protocol using the lung, a highly metastatic tissue in the 4T1 model. Images of methylene blue-stained plates are acquired and uploaded for analysis in Fiji-ImageJ. Fiji-ImageJ then determines the percentage of the selected area of the image that is blue, representing the percentage of the plate with metastatic burden. This computer-based approach offers more consistent and expeditious results than manual counting or histopathological evaluation for highly metastatic tissues. The consistency of Fiji-ImageJ results depends on the quality of the image. Slight variations in results between images can occur, thus it is recommended that multiple images are taken and results averaged. Despite its minimal limitations, this method is an improvement to quantifying metastatic burden in the lung by offering consistent and rapid results.

We describe a more consistent and expeditious method to quantify lung metastasis in the 4T1 breast cancer model by using Fiji-ImageJ.

利用计算机图像分析提高4T1乳腺癌模型中肺转移的定量

Breast cancer is a devastating malignancy, accounting for 40,000 female deaths and 30% of new female cancer diagnoses in the United States in 2019 alone. ...

Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy

Sentinel lymph node (SLN) mapping and biopsy is a promising technique for visualizing and evaluating lymph node status in cancer. This approach has been recommended for low-risk endometrial cancer (EC) patients by authoritative international guidelines, but it has not been performed broadly in China and worldwide. This work aims to describe detailed SLN mapping and biopsy procedures to promote the clinical application. SLN mapping and postoperative pathologic ultrastaging were conducted in a patient with low-risk EC using indocyanine green (ICG) dye to track the SLNs under laparoscopy and resecting them completely for ultrastaging. In conclusion, this protocol describes details of ICG injection, and SLN mapping and biopsy in EC patients based on the experiences gained during clinical practice.

This protocol describes the identification and resection of sentinel lymph nodes to make the operation as easy and minimally invasive as possible.

腹腔镜检查早期子宫内膜癌的前哨淋巴结定位和活检

Sentinel lymph node (SLN) mapping and biopsy is a promising technique for visualizing and evaluating lymph node status in cancer. This approach has been ...

<meta charset="utf8"></head><body>靶向致癌 miRNA-10b 治疗转移性乳腺癌的纳米药物

Monitoring of Nanodrug Accumulation in Murine Breast Cancer Metastases

Metastatic breast cancer is a devastating disease with very limited therapeutic options, calling for new therapeutic strategies. Oncogenic miRNAs have been shown to be associated with the metastatic potential of breast cancer and are implicated in tumor cell migration, invasion, and viability. However, it can be difficult to deliver an inhibitory RNA molecule to the tissue of interest. To overcome this challenge and deliver active antisense oligonucleotides to tumors, we utilized magnetic iron oxide nanoparticles as a delivery platform. These nanoparticles target tissues with increased vascular permeability, such as sites of inflammation or cancer. Delivery of these nanoparticles can be monitored in vivo by magnetic resonance imaging (MRI) due to their magnetic properties. Translation of this therapeutic approach into the clinic will be more accessible because of its compatibility with this relevant imaging modality. They can also be labeled with other imaging reporters such as a Cy5.5 near-infrared optical dye for correlative optical imaging and fluorescence microscopy. Here, we demonstrate that nanoparticles labeled with Cy5.5 and conjugated to therapeutic oligomers targeting oncogenic miRNA-10b (termed MN-anti-miR10b, or &#34;nanodrug&#34;) administered intravenously accumulate in metastatic sites, opening a possibility for therapeutic intervention of metastatic breast cancer.

<meta charset="utf8"></head><body>监测小鼠乳腺癌转移灶中纳米药物的积累

Here, we describe the protocol for in vivo delivery of magnetic iron oxide nanoparticles carrying RNA oligomers to metastatic breast cancer in animal models, providing a clinically viable approach for the therapeutic silencing of oncogenic nucleic acids.

监测小鼠乳腺癌转移灶中纳米药物的积累

Metastatic breast cancer is a devastating disease with very limited therapeutic options, calling for new therapeutic strategies. Oncogenic miRNAs have ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

1%亚甲蓝染料作为单一技术在乳腺癌哨点节点活检中的应用

副本

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此视频中的章节

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

门静脉注射模型来研究肝转移乳腺癌

在Vivo免疫荧光定位中用于评估癌症研究中的治疗和诊断抗体生物分布

术中的微妙的子宫内膜异位症的检测：A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的

利用计算机图像分析提高4T1乳腺癌模型中肺转移的定量

腹腔镜检查早期子宫内膜癌的前哨淋巴结定位和活检

监测小鼠乳腺癌转移灶中纳米药物的积累

监测小鼠乳腺癌转移灶中纳米药物的积累

监测小鼠乳腺癌转移灶中纳米药物的积累

电磁导航经胸结节定位用于微创胸外科手术