caa a22 4500 445333715 CHVBK 20180317142746.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1245/s10434-011-1566-x doi (NATIONALLICENCE)springer-10.1245/s10434-011-1566-x Toward Optimization of Imaging System and Lymphatic Tracer for Near-Infrared Fluorescent Sentinel Lymph Node Mapping in Breast Cancer [Elektronische Daten] [J. Mieog, Susan Troyan, Merlijn Hutteman, Kevin Donohoe, Joost van der Vorst, Alan Stockdale, Gerrit-Jan Liefers, Hak Choi, Summer Gibbs-Strauss, Hein Putter, Sylvain Gioux, Peter Kuppen, Yoshitomo Ashitate, Clemens Löwik, Vincent Smit, Rafiou Oketokoun, Long Ngo, Cornelis van de Velde, John Frangioni, Alexander Vahrmeijer] Background: Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers. Materials and Methods: A small, portable version of the FLARE imaging system, termed Mini-FLARE, was developed for capturing color video and two semi-independent channels of NIR fluorescence (700 and 800nm) in real time. Initial optimization of lymphatic tracer dose was performed using 35-kg Yorkshire pigs and a 6-patient pilot clinical trial. More refined optimization was performed in 24 consecutive breast cancer patients. All patients received the standard of care using 99mTechnetium-nanocolloid and patent blue. In addition, 1.6ml of indocyanine green adsorbed to human serum albumin (ICG:HSA) was injected directly after patent blue at the same location. Patients were allocated to 1 of 8 escalating ICG:HSA concentration groups from 50 to 1000μM. Results: The Mini-FLARE system was positioned easily in the operating room and could be used up to 13 in. from the patient. Mini-FLARE enabled visualization of lymphatic channels and SLNs in all patients. A total of 35 SLNs (mean=1.45, range 1-3) were detected: 35 radioactive (100%), 30 blue (86%), and 35 NIR fluorescent (100%). Contrast agent quenching at the injection site and dilution within lymphatic channels were major contributors to signal strength of the SLN. Optimal injection dose of ICG:HSA ranged between 400 and 800μM. No adverse reactions were observed. Conclusions: We describe the clinical translation of a new NIR fluorescence imaging system and define the optimal ICG:HSA dose range for SLN mapping in breast cancer. The Author(s), 2011 Mieog J. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Troyan Susan Breast Care Center, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Hutteman Merlijn Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Donohoe Kevin Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA aut van der Vorst Joost Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Stockdale Alan Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Liefers Gerrit-Jan Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Choi Hak Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Gibbs-Strauss Summer Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Putter Hein Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands aut Gioux Sylvain Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Kuppen Peter Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Ashitate Yoshitomo Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Löwik Clemens Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands aut Smit Vincent Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands aut Oketokoun Rafiou Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Ngo Long Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut van de Velde Cornelis Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Frangioni John Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut Vahrmeijer Alexander Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut Annals of Surgical Oncology Springer-Verlag 18/9(2011-09-01), 2483-2491 1068-9265 18:9<2483 2011 18 10434 https://doi.org/10.1245/s10434-011-1566-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1566-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mieog J. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Troyan Susan Breast Care Center, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Hutteman Merlijn Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Donohoe Kevin Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- van der Vorst Joost Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Stockdale Alan Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Liefers Gerrit-Jan Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Choi Hak Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Gibbs-Strauss Summer Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Putter Hein Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Gioux Sylvain Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Kuppen Peter Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Ashitate Yoshitomo Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Löwik Clemens Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Smit Vincent Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Oketokoun Rafiou Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Ngo Long Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- van de Velde Cornelis Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Frangioni John Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA aut NATIONALLICENCE 700 1- Vahrmeijer Alexander Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/9(2011-09-01), 2483-2491 1068-9265 18:9<2483 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer