Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer

Purpose Using current optical imaging techniques and gamma imaging modalities, perioperative sentinel lymph node (SLN) identification in colon cancer can be difficult when the SLN is located near the primary tumour or beneath a thick layer of (fat) tissue. Sentinel lymph node mapping using PET/CT ly...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2019-07, Vol.46 (7), p.1495-1505
Main Authors: Ankersmit, M., Hoekstra, O. S., van Lingen, A., Bloemena, E., Jacobs, M. A. J. M., Vugts, D. J., Bonjer, H. J., van Dongen, G. A. M. S., Meijerink, W. J. H. J.
Format: Article
Language:English
Subjects:
Biopsy
Cancer
Cardiology
Colon
Colon cancer
Colorectal cancer
Computed tomography
Feasibility studies
Fluorescence
I.R. radiation
Identification
Imaging
Imaging techniques
Immunohistochemistry
Infrared imaging
Injection
Lymph nodes
Lymphatic system
Mapping
Medical imaging
Medicine
Medicine & Public Health
Metastases
Metastasis
Nuclear Medicine
Oncology
Original
Original Article
Orthopedics
Patients
Positron emission
Radiology
Real time
Surgery
Tomography
Tracers
Tumors
White light
Zirconium isotopes
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Summary:Purpose Using current optical imaging techniques and gamma imaging modalities, perioperative sentinel lymph node (SLN) identification in colon cancer can be difficult when the SLN is located near the primary tumour or beneath a thick layer of (fat) tissue. Sentinel lymph node mapping using PET/CT lymphoscintigraphy combined with real-time visualization of the SLN using near-infrared imaging has shown promising results in several types of cancer and may facilitate the successful identification of the number and location of the SLN in early colon cancer. Methods Clinical feasibility of PET/CT lymphoscintigraphy using preoperative endoscopically injected [ 89 Zr]Zr-Nanocoll and intraoperative injection of the near-infrared (NIR) tracer Indocyanine Green (ICG) was evaluated in ten early colon cancer patients. Three preoperative PET/CT scans and an additional ex vivo scan of the specimen were performed after submucosal injection of [ 89 Zr]Zr-Nanocoll. All SLNs and other lymph nodes underwent extensive pathological examination for metastases. A histopathological proven lymph node visible at preoperative PET/CT and identified at PET/CT of the specimen was defined as SLN. Results A total of 27 SLNs were harvested in seven out of eight patients with successful injection of both tracers. In one patient no SLNs were assigned preoperatively. In two patients injection of [ 89 Zr]Zr-Nanocoll failed due to incorrect needle positioning. Twenty-one (78%) SLNs were found intraoperatively using NIR-imaging. Eleven of the 27 (41%) SLNs were located near the primary tumour (< 2 cm). Those six SLNs not found intraoperatively with NIR-imaging were all located close to the tumour. In all seven patients at least one SLN could be assigned at preoperative imaging 24 h after tracer administration. One SLN contained metastases detected by immunohistochemistry. No metastases were found in the non-SLNs. Conclusions This study shows the potential of preoperative PET/CT lymphoscintigraphy to inform the surgeon about the number and location of SLNs in patients with early colon cancer. The additional use of NIR-imaging allows for intraoperative identification of these SLNs which are invisible with conventional white light imaging. Further research is necessary to improve and simplify the technique. We recommend perioperative SLN identification using a preoperative lymphoscintigraphy scan just before surgery approximately 24 h after injection. Additionally a postoperative scan of the specim
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-019-04284-w