767 INDOCYANINE GREEN (ICG): A NOVEL APPROACH TO PELVIC LYMPH NODE IDENTIFICATION IN RADICAL CYSTECTOMY SPECIMENS (2011)

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011767 INDOCYANINE GREEN (ICG): A NOVEL APPROACH TO PELVIC LYMPH NODE IDENTIFICATION IN RADICAL CYSTECTOMY SPECIMENS Jennifer Gordetsky, Hani Rashid, Guan Wu, Christopher Silvers, Edward Messing, Jorge Yao, and Dragan Golijanin Jennifer GordetskyJennifer Gordetsky Rochester, NY , Hani RashidHani Rashid Rochester, NY , Guan WuGuan Wu Rochester, NY , Christopher SilversChristopher Silvers Rochester, NY , Edward MessingEdward Messing Rochester, NY , Jorge YaoJorge Yao Rochester, NY , and Dragan GolijaninDragan Golijanin Rochester, NY View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1806AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymph node count has prognostic implications in bladder cancer patients who are treated with radical cystectomy. Standard techniques may not identify all lymph nodes, leading to additional effort and expense for report completion. Indocyanine green (ICG), a nontoxic dye with near infrared fluorescence properties, is transferred through lymphatics, allowing for identification of lymph nodes. We investigated the ability of intravesically injected ICG to identify pelvic lymph nodes. METHODS We assessed 14 patients for near infrared fluorescence lymph node imaging using ICG intravesicular injection. 0.5 to 1 ml of ICG (2.5 mg/ml) was injected at the tumor base. Lymph node dissection was performed within 2–4 hours. The SPY imaging system (Novadaq, Bonita Springs, FL, USA) was used to detect ICG fluorescence in pelvic lymph node specimens. Fluorescence was identified both in-vivo (figure 1) during radical cystectomy and ex-vivo (figure 2) in lymph node dissection packets. Potential nodes that had positive fluorescence were confirmed by histologic examination. RESULTS ICG was able to identify lymph nodes in 12 of 14 patients. The number of nodes identified using this technique ranged from 1 to 14 nodes per patient. One lymph node was positive for metastatic high grade urothelial carcinoma. CONCLUSIONS ICG near infrared fluorescence can identify lymph nodes. This simple, nontoxic imaging may prove advantageous for lymph node identification in pelvic lymph node dissection specimens. Currently Carnoy's solution is used to aid in lymph node identification. However, Carnoy's is toxic, hazardous to employees, and requires additional expense for disposal. Carnoy's also requires several hours of tissue penetration for maximum effectiveness, leading to a delay in specimen processing. ICG is non-toxic, requires no additional cost for disposal, and can be used immediately on specimens. Additional investigation is needed to assess this method's sensitivity, specificity and predictive values. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e308-e309 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Gordetsky Rochester, NY More articles by this author Hani Rashid Rochester, NY More articles by this author Guan Wu Rochester, NY More articles by this author Christopher Silvers Rochester, NY More articles by this author Edward Messing Rochester, NY More articles by this author Jorge Yao Rochester, NY More articles by this author Dragan Golijanin Rochester, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...