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CLINICAL TRIAL article

Front. Oncol.
Sec. Surgical Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1384268
This article is part of the Research Topic Applications of Fluorescence in Surgery and Diagnostics Volume II: Evolution and Breakthroughs View all 5 articles

A Preliminary Investigation of Precise Visualization, Localization, and Resection of Pelvic Lymph Nodes in Bladder Cancer by using Indocyanine Green Fluorescence-guided Approach through Intracutaneous Dye Injection into the Lower Limbs and Perineum

Provisionally accepted
Yunmeng Zhang Yunmeng Zhang 1Xinyu Guo Xinyu Guo 1Yueying Zhang Yueying Zhang 2Jinzheng Wei Jinzheng Wei 1Pengyu Yan Pengyu Yan 1Haiming Kang Haiming Kang 1Yang Shu Yang Shu 3Chao Liu Chao Liu 1*Xiaofeng Yang Xiaofeng Yang 1*
  • 1 First Hospital of Shanxi Medical University, Taiyuan, Shaanxi, China
  • 2 University of Shanghai for Science and Technology, Shanghai, Shanghai Municipality, China
  • 3 Shanxi Medical University, Taiyuan, Shanxi Province, China

The final, formatted version of the article will be published soon.

    Abstract Objective: This study aimed to investigate the feasibility and effectiveness of using indocyanine green (ICG) injected intracutaneously through the lower limbs and perineum for visualized tracking, localization, and qualitative assessment of pelvic lymph nodes (LNs) in bladder cancer to achieve their accurate resection. Methods: First, ICG was injected into the LN metastasis model mice lower limbs, and real-time and dynamic in vivo and ex vivo imaging was conducted by using a near-infrared fluorescence imaging system. Additionally, 26 patients with bladder cancer were enrolled and divided into intracutaneous group and transurethral group. A near-infrared fluorescence imaging device with internal and external imaging probes was used to perform real-time tracking, localization, and resection of the pelvic LNs. Results: The mice normal LNs and the metastatic LNs exhibited fluorescence. The metastatic LNs showed a significantly higher signal-to-background ratio than the normal LNs (3.9 ± 0.2 vs. 2.0 ± 0.1, p < 0.05). In the intracutaneous group, the accuracy rate of fluorescent-labeled LNs was 97.6%, with an average of 11.3 ± 2.4 LNs resected per patient. Six positive LNs were detected in three patients (18.8%). In the transurethral group, the accuracy rate of fluorescent-labeled LNs was 84.4%, with an average of 8.6 ± 2.3 LNs resected per patient. Two positive LNs were detected in one patient (12.5%). Conclusions: Following the intracutaneous injection of ICG into the lower limbs and perineum, the dye accumulates in pelvic LNs through lymphatic reflux. By using near-infrared fluorescence laparoscopic fusion imaging, physicians can perform real-time tracking, localization, and precise resection of pelvic LNs. Keywords Bladder cancer. Pelvic lymph node dissection. Near-infrared fluorescence imaging. Indocyanine green. Precise visualization

    Keywords: Bladder cancer, Pelvic lymph node dissection, Near-infrared fluorescence imaging, Indocyanine Green, Precise visualization

    Received: 09 Feb 2024; Accepted: 06 May 2024.

    Copyright: © 2024 Zhang, Guo, Zhang, Wei, Yan, Kang, Shu, Liu and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Chao Liu, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shaanxi, China
    Xiaofeng Yang, First Hospital of Shanxi Medical University, Taiyuan, 030001, Shaanxi, China

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