Fluorescein Isothiocyanate: A Novel Application for Intra-operative Lymphatic Imaging
Dhruv Singhal, MD1, Christiana Shaw, MD1, Adam Katz, MD1, Lifei Guo, MD2, Lisa Spiguel, MD1.
1University of Florida School of Medicine, Gainesville, FL, USA, 2Lahey Clinic, Burlington, MA, USA.
PURPOSE: The LYMPHA technique entails performing a lymphovenous bypass (LVB) at the time of axillary lymph node dissection (ALND) to reduce lymphedema risk. We developed a novel application of fluorescein isothiocyanate (FITC) for intra-operative lymphatic imaging. Our goal is to demonstrate safety and efficacy of FITC for this application.
METHODS:We reviewed a prospectively collected database on breast cancer patients who underwent LYMPHA from March to September 2015. FITC was utilized to identify arm lymphatic channels following ALND in order to perform a LVB between disrupted lymphatics and axillary vein tributaries. (Fig 1) Data on pre- and intra-operative variables was analyzed.
RESULTS: Thirteen patients underwent LYMPHA with intra-operative FITC lymphatic imaging from March to September 2015. Average patient age was 50 years with a mean BMI of 28. On average, 3.4 lacerated lymphatic channels were identified and 1.7 channels were bypassed per patient. Eleven anastomoses were performed to the accessory branch of the axillary vein and 1 to a lateral branch. In 1 patient, a bypass was not performed due to poor lymphatic caliber and inadequate length of vein tributary. No intra-operative adverse events were noted.
CONCLUSION: FITC is a safe and effective method for intra-operative lymphatic imaging. FITC imaging maintains life-like color in non-fluoresced tissues allowing for simultaneous dissection and lymphatic visualization. Moreover, blue dye can now be reserved for use by our oncologic surgeons.
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