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Published on: October 20, 2010
Fluorescence-guided lymph node sampling is feasible during up-front or delayed nephrectomy for Wilms tumor
Abdelhafeez H Abdelhafeez1, Andrew M Davidoff1, Andrew J Murphy1
1Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA.
Fluorescence-guided lymphatic mapping using indocyanine green (ICG) is a feasible technique for identifying draining lymph nodes in Wilms tumor patients. This method shows promise for improving surgical staging accuracy in pediatric cancer.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Accurate lymph node sampling is crucial for staging Wilms tumor, a common pediatric kidney cancer.
- Failure to sample lymph nodes can lead to under-staging and higher local recurrence rates.
- Currently, no standardized lymphatic mapping technique exists for Wilms tumor.
Purpose of the Study:
- To describe the application of fluorescence-guided lymphatic mapping in Wilms tumor.
- To evaluate the feasibility of indocyanine green (ICG) for nodal mapping in this patient population.
Main Methods:
- Two centers utilized ICG fluorescence-guided nodal mapping in Wilms tumor patients.
- Techniques included ipsilateral intra-parenchymal (IP) injection during minimally invasive surgery and Peri-Hilar (PH) injection during open surgery.
- Successful mapping was defined by detecting ICG fluorescence in draining lymph nodes.
Main Results:
- Eight patients (median age 2.5 years) underwent mapping.
- The overall success rate for fluorescence-guided lymphatic mapping was 88% (7 out of 8 patients).
- The IP injection technique was successful in all four patients who received it.
Conclusions:
- Fluorescence-guided lymphatic mapping for Wilms tumor is achievable using both IP and PH injection methods.
- The study demonstrates the feasibility of this technique in pediatric patients.
- Prospective trials are needed to determine if this method enhances the precision of lymph node sampling.
