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

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. Nuclear Medicine Department, CDI, Hospital Clinic Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Sergi Vidal-Sicart, Antonio Seva, Francisco Campos, Núria Sánchez, Andrés Perissinotti & Pilar Paredes

  2. Nuclear Medicine Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain

    Antonio Seva

  3. Gynaecology Department, ICGON, Hospital Clinic Barcelona, Barcelona, Spain

    Immaculada Alonso, Jaume Pahisa & Xavier Caparrós

  4. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Leiden, The Netherlands

    Fijs W. van Leeuwen

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  1. Sergi Vidal-Sicart
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  2. Antonio Seva
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Correspondence to Sergi Vidal-Sicart.

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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.

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Vidal-Sicart, S., Seva, A., Campos, F. et al. Clinical use of an opto-nuclear probe for hybrid sentinel node biopsy guidance: first results. Int J CARS 14, 409–416 (2019). https://doi.org/10.1007/s11548-018-1816-5

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  • DOI: https://doi.org/10.1007/s11548-018-1816-5

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