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Fluorescence-Based Molecular Imaging of Porcine Urinary Bladder Sentinel Lymph Nodes.

  • Lee, Hak J1
  • Barback, Christopher V2, 3
  • Hoh, Carl K2, 3
  • Qin, Zhengtao2, 3
  • Kader, Kareem1
  • Hall, David J2, 3
  • Vera, David R4, 3
  • Kane, Christopher J1
  • 1 Department of Urology, University of California, San Diego, La Jolla, California.
  • 2 Department of Radiology, University of California, San Diego, La Jolla, California; and.
  • 3 UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California.
  • 4 Department of Radiology, University of California, San Diego, La Jolla, California; and [email protected]
Published Article
Publication Date
Apr 01, 2017
DOI: 10.2967/jnumed.116.178582
PMID: 28153955


The primary objective was to test the ability of a laparoscopic camera system to detect the fluorescent signal emanating from sentinel lymph nodes (SLNs) approximately 2 d after injection and imaging of a positron-emitting molecular imaging agent into the submucosa of the porcine urinary bladder. Methods: Three female pigs underwent a submucosal injection of the bladder with fluorescent-tagged tilmanocept, radiolabeled with both 68Ga and 99mTc. One hour after injection, a pelvic PET/CT scan was acquired for preoperative SLN mapping. Approximately 36 h later, robotic SLN mapping was performed using a fluorescence-capable camera system. After identification of the fluorescent lymph nodes, a pelvic lymph node dissection was completed with robotic assistance. All excised nodal packets (n = 36) were assayed for 99mTc activity, which established a lymph node as an SLN. 99mTc activity was also used to calculate the amount of dye within each lymph node. Results: All of the SLNs defined by the ex vivo γ-well assay of 99mTc activity were detected by fluorescence mode imaging. The time between injection and robotic SLN mapping ranged from 32 to 38 h. A total of 5 fluorescent lymph nodes were detected; 2 pigs had 2 fluorescent lymph nodes and 1 pig exhibited a single lymph node. Four of the 5 SLNs exhibited increased SUVs of 12.4-139.0 obtained from PET/CT. The dye content of the injection sites ranged from 371 to 1,441 pmol, which represented 16.5%-64.1% of the injected dose; the amount of dye within the SLNs ranged from 8.5 to 88 pmol, which was equivalent to 0.38%-3.91% of the administered dose. Conclusion: Fluorescent-labeled 68Ga-tilmanocept allows for PET imaging and real-time intraoperative detection of SLNs during robotic surgery. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

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