Abstract
Purpose
For oral cavity malignancies, sentinel lymph node (SLN) mapping is performed by injecting a radiocolloid around the primary tumour followed by lymphoscintigraphy. Surgically, SLNs can then be localized using a handheld gamma ray detection probe. The aim of this study was to evaluate the added value of intraoperative fluorescence imaging to the conventional radioguided procedure. For this we used indocyanine green (ICG)‐99mTc‐nanocolloid, a hybrid tracer that is both radioactive and fluorescent.
Methods
Fourteen patients with oral cavity squamous cell carcinoma were peritumourally injected with ICG-99mTc-nanocolloid. SLNs were preoperatively identified with lymphoscintigraphy followed by single photon emission computed tomography (SPECT)/CT for anatomical localization. During surgery, SLNs were detected with a handheld gamma ray detection probe and a handheld near-infrared fluorescence camera. Pre-incision and post-excision imaging with a portable gamma camera was performed to confirm complete removal of all SLNs.
Results
SLNs were preoperatively identified using the radioactive signature of ICG-99mTc-nanocolloid. Intraoperatively, 43 SLNs could be localized and excised with combined radio- and fluorescence guidance. Additionally, in four patients, an SLN located close to the primary injection site (in three patients this SLN was located in level I) could only be intraoperatively localized using fluorescence imaging. Pathological analysis of the SLNs revealed a metastasis in one patient.
Conclusion
Combined preoperative SLN identification and intraoperative radio- and fluorescence guidance during SLN biopsies for oral cavity cancer proved feasible using ICG-99mTc-nanocolloid. The addition of fluorescence imaging was shown to be of particular value when SLNs were located in close proximity to the primary tumour.
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Acknowledgements
This work was partially supported in part by the Dutch Cancer Society translational research award (Grant No. PGF 2009–4344; FvL) and NWO-STW-VIDI (Grant No. STW BGT11271; NvdB and FvL).
We gratefully thank the entire surgical staff, hospital pharmacy and technical support of the Nuclear Medicine Department for their contribution and Professor T.J.M. Reurs for kindly providing the fluorescence camera system.
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Nynke S. van den Berg and Oscar R. Brouwer contributed equally to the study.
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van den Berg, N.S., Brouwer, O.R., Klop, W.M.C. et al. Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99mTc-nanocolloid. Eur J Nucl Med Mol Imaging 39, 1128–1136 (2012). https://doi.org/10.1007/s00259-012-2129-5
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DOI: https://doi.org/10.1007/s00259-012-2129-5