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Updated: Mar 7, 2026
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided
Suman B Mondal1,2, Shengkui Gao3, Nan Zhu4
1Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
Background:
The inability to visualize the patient and surgical site directly, limits the use of current near infrared fluorescence-guided surgery systems for real-time sentinel lymph node biopsy and tumor margin assessment.
Methods:
We evaluated an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared, fluorescence-guided surgery. Tumor-bearing mice injected with a near infrared cancer-targeting agent underwent fluorescence-guided, tumor resection. Female Yorkshire pigs received hind leg intradermal indocyanine green injection and underwent fluorescence-guided, popliteal lymph node resection. Four breast cancer patients received 99mTc-sulfur colloid and indocyanine green retroareolarly before undergoing sentinel lymph node biopsy using radioactive tracking and fluorescence imaging. Three other breast cancer patients received indocyanine green retroareolarly before undergoing standard-of-care partial mastectomy, followed by fluorescence imaging of resected tumor and tumor cavity for margin assessment.
Results:
Using near-infrared fluorescence from the dyes, the optical see-through GAINS accurately identified all mouse tumors, pig lymphatics, and four pig popliteal lymph nodes with high signal-to-background ratio. In 4 human breast cancer patients, 11 sentinel lymph nodes were identified with a detection sensitivity of 86.67 ± 0.27% for radioactive tracking and 100% for GAINS. Tumor margin status was accurately predicted by GAINS in all three patients, including clear margins in patients 1 and 2 and positive margins in patient 3 as confirmed by paraffin-embedded section histopathology.
Conclusions:
The optical see-through GAINS prototype enhances near infrared fluorescence-guided surgery for sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting the surgical workflow in the operating room.
Insights
This study introduces an augmented reality system for enhanced near-infrared fluorescence-guided surgery. The GAINS system accurately guides sentinel lymph node biopsy and tumor margin assessment in breast cancer patients.
Area of Science:
- Medical Imaging
- Surgical Technology
- Oncology
Background:
- Current near-infrared fluorescence-guided surgery systems face limitations in direct visualization for real-time sentinel lymph node biopsy and tumor margin assessment.
- Direct visualization of the patient and surgical site is crucial for accurate surgical guidance.
Purpose of the Study:
- To evaluate an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared, fluorescence-guided surgery.
- To assess the system's efficacy in sentinel lymph node biopsy and tumor margin assessment.
Main Methods:
- The GAINS system was evaluated in tumor-bearing mice, Yorkshire pigs, and breast cancer patients undergoing sentinel lymph node biopsy and tumor margin assessment.
- Near-infrared fluorescence imaging with cancer-targeting agents and indocyanine green was utilized.
Main Results:
- GAINS accurately identified tumors in mice, lymphatics in pigs, and sentinel lymph nodes in human patients with 100% detection sensitivity.
- The system accurately predicted tumor margin status in all evaluated breast cancer patients, confirmed by histopathology.
Conclusions:
- The optical see-through GAINS prototype significantly enhances near-infrared fluorescence-guided surgery.
- GAINS improves sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting surgical workflow.
