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Clinical use of an opto-nuclear probe for hybrid sentinel node biopsy guidance: first results

  • Sergi Vidal-SicartEmail author
  • Antonio Seva
  • Francisco Campos
  • Núria Sánchez
  • Immaculada Alonso
  • Jaume Pahisa
  • Xavier Caparrós
  • Andrés Perissinotti
  • Pilar Paredes
  • Fijs W. van Leeuwen
Original Article

Abstract

Introduction

Guidelines advocate the use of combined detection techniques to achieve optimal results for sentinel node (SN) biopsy. The fluorescent and radioactive (dual-) tracer ICG-99mTc-nanocolloid has been shown to facilitate SN biopsy in several indications. It was reported that an opto-nuclear probe permitted the detection of near-infrared fluorescence and gamma-rays. The aim of the current study was to evaluate this device in a large patient group and to test it in both open and laparoscopic surgery implications.

Methods

Thirty-three patients scheduled for SN biopsy with the dual-tracer were retrospectively analyzed. Pre-operative lymphoscintigraphy was performed in all patients; in 18 patients (55%), a SPECT/CT scan was also performed. Radioactive and fluorescent signatures in the SNs were assessed in vivo and ex vivo using the opto-nuclear probe.

Results

One or more SNs were identified in all patients (identification rate 100%). Planar lymphoscintigraphic images revealed 95 hot spots that were considered as SNs. This number increased to 103 SNs when SPECT/CT was used. During surgery, 106 SNs were excised. In vivo, the fluorescence mode of the opto-nuclear probe was able to locate 79 SNs (74.5%). When the gamma-ray detection option of the same probe was used, this number increased to 99 SNs (93.3%). Ex vivo analysis revealed fluorescence in 93.3% of the excised nodes and radioactivity in 95.2%.

Conclusions

This study underlines the feasibility of using the dual-tracer/opto-nuclear probe combination for SN resections. The use of the opto-nuclear technology has been extended to laparoscopic surgery. This study also underlines the fluorescence tracing can complement traditional radio-tracing approaches.

Keywords

Bi-modal Image-guided surgery Sentinel node Fluorescence SPECT Hybrid Dual-tracer 

Notes

Acknowledgements

We deeply thank Eurorad for supporting the clinical evaluation by providing an opto-nuclear device.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

11548_2018_1816_MOESM1_ESM.docx (32 kb)
Supplementary material 1 (DOCX 32 kb)

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Copyright information

© CARS 2018

Authors and Affiliations

  • Sergi Vidal-Sicart
    • 1
    Email author
  • Antonio Seva
    • 1
    • 2
  • Francisco Campos
    • 1
  • Núria Sánchez
    • 1
  • Immaculada Alonso
    • 3
  • Jaume Pahisa
    • 3
  • Xavier Caparrós
    • 3
  • Andrés Perissinotti
    • 1
  • Pilar Paredes
    • 1
  • Fijs W. van Leeuwen
    • 4
  1. 1.Nuclear Medicine Department, CDIHospital Clinic BarcelonaBarcelonaSpain
  2. 2.Nuclear Medicine DepartmentHospital Central de la Defensa Gómez UllaMadridSpain
  3. 3.Gynaecology Department, ICGONHospital Clinic BarcelonaBarcelonaSpain
  4. 4.Interventional Molecular Imaging Laboratory, Department of RadiologyLeiden University Medical HospitalLeidenThe Netherlands

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