Development of novel tracers for sentinel node identification in cervical cancer

Indocyanine green (ICG) with near‐infrared (NIR) fluorescence imaging is used for lymphatic mapping. However, binding of ICG to blood proteins like serum albumin can shorten its retention time in sentinel lymph nodes (SLNs). Here, we investigated the efficacy and safety of a new fluorescence tracer comprising phytate and liposome (LP)‐encapsulated ICG. Coadministration of phytate with LP containing phosphatidic acid promotes chelation mediated by Ca(2+) in bodily fluids to enhance SLN retention. Uniformly sized LPs (100 nm) encapsulating ICG under conditions that minimized fluorescence self‐quenching during storage were produced. We analyzed the behavior of the new tracer (ICG‐phytate‐LP) and control tracers (ICG and ICG‐LP) in the lymphatic flow of mice in terms of lymph node retention time. We also tested lymphatic flow and safety in pigs that have a more human‐like lymphatic system. LPs encapsulating stabilized ICG were successfully prepared. Mixing LP with phytate in the presence of Ca(2+) increased both the particle size and negative surface charge. In mice, ICG‐phytate‐LP had the best lymph node retention, with a fluorescence intensity ratio that increased over 6 h and then decreased slowly over the next 24 h. In pigs, administration of ICG and ICG‐phytate‐LP resulted in no death or weight loss. There were no obvious differences between blood test results for the ICG and ICG‐phytate‐LP groups, and the overall safety was good. ICG‐phytate‐LP may be a useful new tracer for gynecological cancers that require time for lymph node identification due to a retroperitoneal approach.