Skip to main content
SpringerLink
Log in

Furthering Precision in Sentinel Node Navigational Surgery for Oral Cancer: a Novel Triple Targeting System

  • SHORT COMMUNICATION
  • Published:
Journal of Fluorescence Aims and scope Submit manuscript

Abstract

To describe an innovative sentinel lymph node (SLN) guidance approach using a radionuclide tracer, 3D augmented reality-guided imaging, and near infrared (NIR) fluorescence over-lay imaging with hand-held probes to optimize accuracy, efficiency, and precise navigation for sentinel node (SN) localization in head and neck cancer. In a cT1N0M0 squamous cell carcinoma of the tongue, pre-operative radionuclide lymphoscintigraphy was performed with a sentinel node-specific radiolabeled tracer. Intraoperatively, a 3D hand-held augmented reality (AR) scanning SPECT probe assessed concordance of the SN with pre-operative SPECT-CT images. The real-time optical video was linked to the SPECT-CT images for added precision. Final guidance to the SN was performed using ICG fluorescence imaging. Dynamic and SPECT-CT showed bilateral lymphatic drainage from the tumor. The 3D hand-held AR SPECT probe SN localization was concordant with pre-operative imaging. The optical video successfully demonstrated the lymphatic drainage in real-time through a unique overlay fluorescence image. The ICG localized to the same nodes identified by both the SPECT-CT and hand-held SPECT images. The use of dual radiation and fluorescence tracers improved SN detection, especially for SN close to the injection site. The hand-held probes allowed the surgeon to dissect continuously, without needing to change tools. The combination of augmented reality, nuclear medicine, and over-lay fluorescence imaging allowed greater accuracy for matching the preoperative imaging with intraoperative identification and precisely guiding the dissection. This method uniquely permitted the surgeon to efficiently dissect the SN with accurate visualization and optimal precision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Broglie MA, Stoeckli SJ (2011) Relevance of sentinel node procedures in head and neck squamous cell carcinoma. Q J Nucl Med Mol Imaging 55:509–520

    PubMed  CAS  Google Scholar 

  2. Coughlin A, Resto VA (2010) Oral cavity squamous cell carcinoma and the clinically N0 neck: the past, present, and future of sentinel lymph node biopsy. Curr Oncol Rep 12:129–135

    Article  PubMed  PubMed Central  Google Scholar 

  3. Murase R, Tanaka H, Hamakawa T et al (2015) Double sentinel lymph node mapping with indocyanine green and 99 m-technetium-tin colloid in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 44:1212–1217

    Article  PubMed  CAS  Google Scholar 

  4. Nieweg OE, Jansen L, Kroon BB (1998) Technique of lymphatic mapping and sentinel node biopsy for melanoma. Eur J Surg Oncol 24:520–524

    Article  PubMed  CAS  Google Scholar 

  5. Kapteijn BA, Nieweg OE, Liem I et al (1997) Localizing the sentinel node in cutaneous melanoma: gamma probe detection versus blue dye. Ann Surg Oncol 4:156–160

    Article  PubMed  CAS  Google Scholar 

  6. Brouwer OR, Buckle T, Bunschoten A et al (2012) Image navigation as a means to expand the boundaries of fluorescence-guided surgery. Phys Med Biol 57:3123–3136

    Article  PubMed  Google Scholar 

  7. van den Berg NS, Brouwer OR, Klop WM et al (2012) Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-(99 m)Tc-nanocolloid. Eur J Nucl Med Mol Imaging 39:1128–1136

    Article  PubMed  CAS  Google Scholar 

  8. Hayashi T, Furukawa H, Oyama A et al (2012) Sentinel lymph node biopsy using real-time fluorescence navigation with indocyanine green in cutaneous head and neck/lip mucosa melanomas. Head Neck 34:758–761

    Article  PubMed  Google Scholar 

  9. Nakamura Y, Fujisawa Y, Nakamura Y et al (2013) Improvement of the sentinel lymph node detection rate of cervical sentinel lymph node biopsy using real-time fluorescence navigation with indocyanine green in head and neck skin cancer. J Dermatol 40:453–457

    Article  PubMed  Google Scholar 

  10. Brouwer OR, Buckle T, Vermeeren L et al (2012) Comparing the hybrid fluorescent-radioactive tracer indocyanine green-99mTc-nanocolloid with 99mTc-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and SPECT/CT. J Nucl Med 53:1034–1040

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors received no financial support for this work.

Author information

Authors and Affiliations

  1. Department of Surgery and Interventional Sciences, University College London Hospitals, NHS Trusts, GENIE Centre, University College London, 235 Euston Rd, NW1 2BU, London, UK

    Manish Chand, Deborah S. Keller & Laurence Devoto

  2. Head and Neck Centre, University College London Hospitals, NHS Trusts, London, UK

    Mark McGurk

Authors
  1. Manish Chand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah S. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laurence Devoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark McGurk
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M. C made substantial contributions to conception and design, acquisition of data, was involved in drafting the manuscript and revising it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. D. S. K. made substantial contributions to conception and design, acquisition of data, was involved in drafting the manuscript and revising it critically for important intellectual content, and gave final approval of the version to be published. L. D. made substantial contributions to conception and design, acquisition of data, was involved in drafting the manuscript and revising it critically for important intellectual content, and gave final approval of the version to be published. M. M. made substantial contributions to conception and design, acquisition of data, was involved in drafting the manuscript and revising it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Manish Chand.

Ethics declarations

Conflict of Interest

Mr. Chand is a consultant for Novadaq Technologies outside of the scope of this work. Mr. Chand has received speaker and teaching honorarium from Novadaq Technologies unrelated to this work. Dr, Keller declares that she has no conflict of interest. Dr. Devoto declares that he has no conflict of interest. Professor McGurk declares that he has no conflict of interest.

Ethics Approval and Consent to Participate

This work involves no experimental devices for human participants. Informed consent was obtained from all individual participants included in the study. 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. This article does not contain any studies with animals performed by any of the authors.

Competing Interests

Mr. Chand, Dr. Keller, Dr. Devoto, and Professor McGurk have no competing interests.

Consent for Publication

Consent for publication was obtained from the individual to cover use of any data; this is available upon request.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chand, M., Keller, D.S., Devoto, L. et al. Furthering Precision in Sentinel Node Navigational Surgery for Oral Cancer: a Novel Triple Targeting System. J Fluoresc 28, 483–486 (2018). https://doi.org/10.1007/s10895-018-2211-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10895-018-2211-x

Keywords

Search

Navigation