Name: multispectral real-time fluorescence imaging for intraoperative detection of the sentinel lymph node in gynecologic oncology
Uploaded: 2010-10-20T17:00:00
Duration: 6 min 37 s
Description: Watch this Scientific Journal Video about Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology at JoVE.com

我们感谢夫人伊奈Wesselman或人员的培训和规划。

1。术中多光谱荧光相机<ol><li>在生物和医学影像学研究所密切合作SurgOptix（SurgOptix公司，加州Redwood Shores，CA，美国）（IBMI，技术大学/亥姆霍兹，慕尼黑，德国）开发一个定制的摄像系统。术中多光谱荧光摄像系统的设置如图2所示。 </li><li>光线穿过一个光学系统，并转化为可见光，在发射（荧光）波段的光线和光激发波段分离。这些捆绑检测的CCD摄像头（CCD）的（图2）。所有摄像机的多光谱信号进行处理，以正确的文物和产量真正的定量荧光生物分布。彩色和荧光信号可外接显示器上显示为单独的图像，或在一个图像叠加。 </li><li>相机的激发和发射滤波器设置在此处的测量，分别在750 nm和800 ± 20 nm的收集。 </li></ol> 2。光造影剂的制备<ol><li>荧光造影剂吲哚菁绿（ICG的，Pulsion公司，德国慕尼黑）在无菌条件下做好了准备。 0.5毫克/毫升的浓度使用。重要的是要使用无菌蒸馏水，而不是氯化钠（NaCl），因为后者会导致总ICG的。 </li><li>配制后，该解决方案必须存放在阴凉的地方，以避免漂白的荧光强度的迅速恶化。注：从这个角度提出保持避光ICG的。 </li></ol> 3。术中影像 - 安装和注射ICG的<ol><li>相机定位，并开始在手术室，在手术前，以尽量减少干扰与标准的外科手术，并连接到高清晰度的屏幕（图2B）。 </li><li>相机中介绍了标准的无菌窗帘，研究者在无菌或衣物（卡尔蔡司光学BV，Sliedrecht，荷兰，OPMI披风楼盘306071）。 </li><li>注：护理是采取使用消毒剂只有明确，作为有色消毒剂往往autofluorescent，可能会干扰成像过程。此外，无菌窗帘和手术标记可以autofluorescent。这是建议，测试或和经营领域中用于手术前自体荧光的所有材料。 </li><li>荧光造影剂吲哚菁绿（ICG）是在无菌条件下做好了准备。 0.5毫克/毫升的浓度使用。重要的是要使用无菌蒸馏水和氯化钠，因为后者会导致总ICG的。配制后，该解决方案必须存放在阴凉的地方避免荧光强度的迅速恶化。注：最好是更换手套后，ICG的准备，因为即使少量ICG的泄漏会影响图像的质量。 </li><li>成像过程开始后，打开腹部。感兴趣的领域是暴露时，相机是机动到经营领域。变焦和对焦，在无菌条件下进行调整。在手术室的灯都关掉，以更好地检测荧光信号。 </li><li> 1.0毫升0.5毫克/毫升ICG的是混合1.0毫升标准的蓝色染料（专利蓝/ BLEU patenté，加柏，法国）在一个注射器。外科医生在四个象限的原发肿瘤周围注入造影剂，防止泄漏的代理。注：在泄漏ICG的手术手套的情况下，有必要更换手套。静止图像或实时视频采集的淋巴流动和外观的荧光前哨淋巴结（图3）。所有的图像和视频直接保存在电脑上。 </li><li>除了荧光，SLN的检测标准协议，使用伽玛探测或目视检查为一个蓝色的变色，或两者。放射性示踪是一般管理的前一天，手术后，是一种放射性前哨淋巴结检测的一个lymphoscintigram。这是标准程序的一部分，并没有在荧光成像协议。 </li><li>实时荧光和蓝色的变色淋巴结切除的SLN是指导。摄像头的实时功能，有助于发现任何残留的荧光或荧光节点意想不到的本地化。 </li><li>前哨淋巴结切除后， 体内的图像采集所有切除淋巴结的荧光信号的存在。曝光时间可以延长更高的分辨率时拍摄的静止图像（图4）。 </li><li>淋巴结的病理组织学检查显示肿瘤细胞的存在或前哨淋巴结的情况下。 </li></ol> 4。 řepresentative结果检测荧光的淋巴结可以与一个高信号背景比。此外，通过淋巴管ICG的流动可以监控允许实时淋巴结映射。结果可能会影响通过增加节点的深度，可能需要不同的光照程序，以实现检测。未来的应用可能提供特定的肿瘤靶向荧光剂术检测与癌症细胞，使用这一技术的积极的SLN。 <img src="/files/ftp_upload/2225/2225fig1.jpg" alt="图1" /> 图1。前哨淋巴结（SLN）的理论。SLN的是第一个从肿瘤引流淋巴结（S）。 <img src="/files/ftp_upload/2225/2225fig2.jpg" alt="图2" /> 图2。多光谱荧光摄像系统原理图图片（一）。在手术室的摄像系统的基本设置（二） 。 <img src="/files/ftp_upload/2225/2225fig4.jpg" alt="图3" /> 图3。在外阴癌的淋巴结多光谱荧光 成像在体内（一）淋巴结的彩色图像。同样的淋 ​​巴结，在体内（B）的荧光图像。伪彩色荧光图像上叠加的彩色图像（三）。 <img src="/files/ftp_upload/2225/2225fig5.jpg" alt="图4" /> 图4。淋巴结在宫颈癌前体内的多光谱荧光成像 。 淋巴结体外（一）的彩色图像。荧光图像相同的淋巴结，体外（二） 。伪彩色荧光图像上叠加的彩色图像（三）。

<ol>
	<li>Tinga, D. J., Bouma, J., Aalders, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patients+with+squamous+cell+versus+adeno(squamous)+carcinoma+of+the+cervix,+what+factors+determine+the+prognosis.">Patients with squamous cell versus adeno(squamous) carcinoma of the cervix, what factors determine the prognosis.</a> Int J Gynecol Cancer. 2 (2), 83-91 (1992).</li><li>McMahon, C. J., Rofsky, N. M., Pedrosa, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+metastases+from+pelvic+tumors:+anatomic+classification,+characterization,+and+staging.">Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging.</a> Radiology. 254 (1), 31-46 (2010).</li><li>Zivanovic, O., Khoury-Collado, F., Abu-Rustum, N. R., Gemignani, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sentinel+lymph+node+biopsy+in+the+management+of+vulvar+carcinoma,+cervical+cancer,+and+endometrial+cancer.">Sentinel lymph node biopsy in the management of vulvar carcinoma, cervical cancer, and endometrial cancer.</a> Oncologist. 14 (7), 695-705 (2009).</li><li>Fuller, J., Guderian, D., Kohler, C., Schneider, A., Wendt, T. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymph+edema+of+the+lower+extremities+after+lymphadenectomy+and+radiotherapy+for+cervical+cancer.">Lymph edema of the lower extremities after lymphadenectomy and radiotherapy for cervical cancer.</a> Strahlenther Onkol. 184 (4), 206-211 (2008).</li><li>Ayhan, A., Celik, H., Dursun, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+mapping+and+sentinel+node+biopsy+in+gynecological+cancers:+a+critical+review+of+the+literature.">Lymphatic mapping and sentinel node biopsy in gynecological cancers: a critical review of the literature.</a> World J Surg Oncol. 6, 53-53 (2008).</li><li>Tanis, P. J., Nieweg, O. E., Valdes Olmos, R. A., Rutgers, E. J., Kroon, B. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+sentinel+node+and+validation+of+the+technique.">History of sentinel node and validation of the technique.</a> Breast Cancer Res. 3 (2), 109-112 (2001).</li><li>Ghobashy, A. E. E. l., Saidi, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sentinel+lymph+node+sampling+in+gynaecological+cancers:+techniques+and+clinical+applications.">Sentinel lymph node sampling in gynaecological cancers: techniques and clinical applications.</a> Eur J Surg Oncol. 35 (7), 675-685 (2009).</li><li>Alford, R., Simpson, H. M., Duberman, J., Hill, G. C., Ogawa, M., Regino, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Toxicity+of+organic+fluorophores+used+in+molecular+imaging:+literature+review.">Toxicity of organic fluorophores used in molecular imaging: literature review.</a> Mol Imaging. 8 (6), 341-354 (2009).</li><li>Themelis, G., Yoo, J. S., Soh, K. S., Schulz, R., Ntziachristos, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+intraoperative+fluorescence+imaging+system+using+light-absorption+correction.">Real-time intraoperative fluorescence imaging system using light-absorption correction.</a> J Biomed Opt. 14 (6), 064012-064012 (2009).</li></ol>

VN和GMvD科学SurgOptix公司董事会成员的程序之前，研究协议是由当地的研究审查委员会（IRB）和知情同意从病人获得批准。

本视频演示了术中的多光谱荧光成像技术的应用术中前哨淋巴结在妇科肿瘤（SLN）的检测。这一方法比传统的SLN的过程具有一定的优势。注射液在手术过程本身，而不是一个手术前的一天，这是更有耐心友好的麻醉与病人的地方，尤其是在妇科癌症。此外，术中成像提供淋巴液的流动，其排水模式的SLN，而不是通过盖革取款间接与直接的视觉反馈的外科医生。在子宫颈癌，其中位于骨盆深部淋巴结，这可能有助于提高检测。 然而，最大的意义在于实现有针对性的成像步骤的办法。针对性的荧光造影剂可能是专门针对肿瘤细胞的肿瘤特异性抗体或基板融合。在这种方式下，术中荧光成像有很大的潜力，从根本上改变目前的做法肿瘤外科。

A correction was made to <a href="http://www.jove.com/index/details.stp?id=2225">Live Imaging of Dense-core Vesicles in Primary Cultured Hippocampal Neurons</a>. There was an error with an author's name. The author name was corrected to include a first initial as follows:
K. Tim Buddingh
instead of:
Tim Buddingh

A correction to an authors name has been made for the article Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology.

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

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<td>Indocyanine Green (ICG)</td>
<td>&nbsp;</td>
<td>Pulsion Medical Systems AG, Munich, Germany</td>
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<td>Patent blue / Bleu patent&eacute;</td>
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<td>Multispectral fluorescence camera system </td>
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multispectral real-time fluorescence imaging for intraoperative detection of the sentinel lymph node in gynecologic oncology

在几乎所有的固体肿瘤的预后取决于淋巴结转移的存在或缺乏 。1-3手术治疗，最常见的结合在全流域面积的肿瘤淋巴结清扫肿瘤根治术。然而，切除淋巴结是由于感染，伤口破裂和淋巴水肿的发病率与 4,5作为一种替代方法，前哨淋巴结（SLN）的过程是发达国家几十年前发现第一排从肿瘤淋巴结6 lymphogenic传播的情况下，前哨淋巴结是第一个淋巴结，受影响（图1）。因此，如果前哨淋巴结不包含转移，下游的淋巴结也将是免费的肿瘤转移，需要不被删除。 SLN的过程是许多类型的肿瘤，如乳腺癌和黑色素瘤，也为外阴和子宫颈的癌治疗的一部分。瘤周注射radiocolloid 有一天7目前前哨淋巴结检测的标准方法是在手术前，和彩色染料术。在子宫颈癌和外阴癌程序的缺点是多次注射在生殖器部位，从而增加对病人的心理困扰，并使用放射性胶体。 多光谱荧光成像技术是一种新兴的的成像方式，可应用于无需要注射radiocolloid术。对于荧光成像术中，需要两个组件：一个荧光剂和定量术中成像的光学系统。作为荧光，我们用吲哚青绿（ICG）。几十年来一直使用全球导航卫星系统国际委员会，以评估心脏功能，脑血流灌注和肝脏灌注。8它是一种惰性药物与药物生物安全的个人资料。在约750 nm的激发时，它发出的光在约800纳米的近红外光谱。一个定制的多光谱荧光成像摄像机系统使用9 。 此视频文章的目的是展示使用荧光成像术在子宫颈癌和外阴癌患者的前哨淋巴结的检测。荧光成像用结合的标准程序，包括radiocolloid和蓝色染料。在未来，术中荧光成像可能会取代目前的方法，也很容易转移到其他迹象，如乳房癌和黑色素瘤。

Watch this Scientific Journal Video about Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology at JoVE.com

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

荧光成像是一种很有前途的肿瘤外科图像引导手术的创新方式。在这个视频中，我们描述了检测使用荧光成像技术在妇科oncologicy展示的前哨淋巴结节点技术的过程。多光谱荧光摄像系统，连同荧光剂吲哚青绿，是应用。

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

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