LYMPHATIC MAPPING AND SENTINEL LYMPH NODE BIOPSY IN THE PATIENTS WITH BREAST CANCER

Objective: To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary node. Methods: 33 patients with breast cancer intraoperatively and postoperatively underwent a lymphatic mapping and the SNB using Patent Blue. Results: The SLNs were found in 30 of 33 patients (90.9%), the SLN accurately predicted the status of the axillary in 29 (96.7%). In one case the SLN was negative, but other axillary nodes were tumor positive. Conclusion: This study confirmed that the procedure of lymphatic mapping and SNB in the patients with breast cancer is feasibility, and that the histological characteristics of the SLN accurately predict the status of the axillary node. We believe that this technique might replace axillary lymph node dissection for breast cancer patients with negative axillae in the future.

What's wrong with sentinel node mapping in colon cancer?

Despite near-universal embrace of the concept and clinical relevance of lymphatic mapping for sentinel node identification and analysis for cancers of the breast and integument,the same technique has struggled to a find a role in gastrointestinal cancers in general and,perhaps,in colon cancer in particular. Despite many studies demonstrating its feasibility in malignancies of the large bowel,concern is continually aroused by the variable and often unacceptably low sensitivity rates. Additionally,many confess uncertainty as to what benefit it could ever confer to patients even if it were proven sufficiently accurate given that standard surgical resection incorporates mesenteric resection anyway. However,the huge impact sentinel node mapping has had on clinical practice in certain cancers means that each of these aspects merit careful reconsideration,from very first principles.

Advances in surgical techniques for gastric cancer:Indocyanine green and near-infrared fluorescence imaging.Is it ready for prime time?

Surgery is still the primary curative treatment for gastric cancer,which includes resection of the tumor with adequate margins and extended lymphadenectomy.In order to improve the operative results and the quality of life of patients,several endeavors have been made toward precision medicine through image-guided surgery,allowing access to real-time intraoperative anatomy and accurate tumor staging.The goal of the surgeon is to achieve a more precise,individualized,and less invasive surgery without compromising oncological efficiency and safety.In this perspective,we have demonstrated the role of indocyanine green(ICG)and near-infrared(NIR)fluorescence imaging method in gastric cancer surgery.This technique may be used to improve localization of the tumor,detection of sentinel lymph nodes(SLN),real-time lymphatic mapping,and blood flow assessment(anastomosis perfusion).

Distal-to-proximal sequential ICG injection technique(DOPSIT)for lymphatic vessels mapping

Supermicrosurgical lymphaticovenular anastomosis(LVA)is the most sought-after procedure among lymphedema patients.However,the same enthusiasm is currently not shared among lymphedema surgeons due to the lackluster results of LVA.The common unfavorable experience with this famed procedure is at least partially caused by the difficulty in finding the lymph vessels.We share our time-tested indocyanine green-based lymph vessel mapping technique,which has helped us establish LVA as our procedure for all fluid-predominant lymphedema.

Highly-Sensitive Multiplexed in vivo Imaging Using PEGylated Upconversion Nanoparticles

Lanthanide-based upconversion nanoparticles(UCNPs)have been widely explored in various fields,including optical imaging,in recent years.Although earlier work has shown that UCNPs with different lanthanide(Ln3+)dopants exhibit various colors,multicolor-especially in vivo multiplexed biomedical imaging-using UCNPs has rarely been reported.In this work,we synthesize a series of UCNPs with different emission colors and functionalize them with an amphiphilic polymer to confer water solubility.Multicolor in vivo upconversion luminescence(UCL)imaging is demonstrated by imaging subcutaneously injected UCNPs and applied in multiplexed in vivo lymph node mapping.We also use UCNPs for multicolor cancer cell labeling and realize in vivo cell tracking by UCL imaging.Moreover,for the first time we compare the in vivo imaging sensitivity of quantum dot(QD)-based fluorescence imaging and UCNP-based UCL imaging side by side,and find the in vivo detection limit of UCNPs to be at least one order of magnitude lower than that of QDs in our current non-optimized imaging system.Our data suggest that,by virtue of their unique optical properties,UCNPs have great potential for use in highly-sensitive multiplexed biomedical imaging.