Fluorescence lymphography using indocyanine green ICG

lymphatic mapping, Fluorescence lymphography, lymphatic alterations, lymphatic vessel abnormalities, clinical trials, lymphatic capillary regeneration, orbital lymphatics, lymph fluid physiology, lymph fluid, cutaneous periarteritis nodosa, lymph detox, Lymphatic Vessel Hyperplasia, puffy hand syndrome, lymphatic valves, lymph flow, lymphedema roadshow, Thoracic lymphatics, Abdominal Lymphatics

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Fluorescence lymphography using indocyanine green ICG

Postby patoco » Fri May 25, 2007 8:06 am

The amount of information and studies involving mapping of the lymphatic system is simply exploding as physicians are trying to learn how to "see" the lymphatic flow in detail. This is the first of two new pages involving new radiological techniques.

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Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema.

J Vasc Surg. 2007 May

Unno N, Inuzuka K, Suzuki M, Yamamoto N, Sagara D, Nishiyama M, Konno H.
Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. unno@hama-med.ac.jp

Keywords: Fluorescence lymphography, indocyanine green, ICG, lymphoscintigraphy

BACKGROUND: Lymphoscintigraphy has largely been performed to diagnose lymphedema. It is, however a time-consuming and expensive technique, which has not been covered by Japanese medical insurance since the year 2002. In this report we introduce a new imaging technique of fluorescent lymphography to diagnose lymphedema.

METHODS: Fluorescence images of subcutaneous lymphatic drainage after subcutaneous injection of indocyanine green (ICG) at the foot were obtained using a newly developed near-infrared camera system. ICG fluorescent lymphography was performed in 12 patients with secondary lymphedema and 10 healthy volunteers. The 12 patients were diagnosed with secondary lymphedema according to the medical history and lymphoscintigram, of which 11 had a history of hysterectomy with extended lymph node dissection and local radiation therapy for uterine cancer. Lymphedema developed in one patient after femorotibial artery bypass for peripheral artery occlusive disease.

RESULTS: Four abnormal fluorescent patterns of the lymph drainage were observed in lymphedema: dermal backflow (an abnormal filling of the lymph capillaries), extended fluorescent signal at the dorsum and plantar region of the foot, dilated lymph channels with proximal obliteration, and diffuse glittering of fluorescent signals with scattered twinkling of the dye. Continuous lymph channels from the injection site of the foot to the groin were observed along the medial aspect of thigh in healthy subjects.

CONCLUSION: ICG fluorescence lymphography is safe, simple, and minimally invasive. The device is portable and easy to use. The technique may be useful in clinical practice to identify presence of lymphatic disorder.

http://www.jvascsurg.org/article/PIIS07 ... 7/abstract

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Novel Lymphography Using Indocyanine Green Dye for Near-Infrared Fluorescence Labeling.

Ann Plast Surg. 2007 Jun

Ogata F, Azuma R, Kikuchi M, Koshima I, Morimoto Y.
From the *Departments of Medical Engineering, daggerPlastic Surgery, and double daggerIntegrative Physiology and Bio-Nano Medicine, National Defense Medical College, Saitama, Japan; and section signPlastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Lymphedema is known to be caused by many pathologic conditions; however, its diagnostic and therapeutic strategies remain to be unestablished. In this study, we investigated the usefulness of a novel lymphographic method based on fluorometric sensing using indocyanine green (ICG) dye for imaging lymphatic vessels using rat models. The real-time imaging system enabled visualization of superficial lymphatic vessels with a diameter of 0.1 mm in 33 frames/second. In addition, morphologic changes in lymphatic vessels in a radiation-induced lymphedema model were detected even at the latent stage. These results suggest that this imaging technique is acceptable as an evaluation method for the lymphatic system.

PMID: 17522489 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer.

Breast Cancer. 2005

Kitai T, Inomoto T, Miwa M, Shikayama T.
Department of Surgery, Nara Social Security Hospital 1-62 Asahicho Yamatokoriyama Nara 639-1013, Japan. tmhs8943@kcn.ne.jp

Key words: Sentinel lymph node biopsy, Breast cancer, Indocyanine green, Fluorescence imaging, Navigation surgery

BACKGROUND: Sentinel lymph node biopsy using a vital dye is a convenient and safe method to assess lymph node status in breast cancer. However, intensive training is necessary to obtain a satisfactory detection rate and to avoid false-negative results. This paper presents a novel method using indocyanine green fluorescence imaging to detect sentinel lymph nodes.

METHODS: Fluorescence images were obtained using a charge coupled device camera with a cut filter as the detector, and light emitting diodes at 760 nm as the light source. When indocyanine green was injected around the areola, subcutaneous lymphatic channels draining from the areola to the axilla were visible by fluorescence within a few minutes. The sentinel lymph node was then dissected by fluorescence navigation.

RESULTS: Sentinel lymph node biopsy using the present method was performed on eighteen patients. Subcutaneous lymphatics were detectable by fluorescence in all patients, and sentinel nodes were successfully identified in 17 of 18 cases (detection rate:94%). It was possible to detect the lymphatic channels and nodes receiving indocyanine green with higher sensitivity by the fluorescence signal than by the green color.

CONCLUSION: Sentinel node biopsy guided by indocyanine green fluorescence imaging is a promising technique for further clinical exploration.

http://www.jstage.jst.go.jp/article/jbc ... 1/_article

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Pat O'Connor
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