Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer
- Resource Type
- Authors
- Wilhelmus J. H. J. Meijerink; M. A. J. M. Jacobs; G.A.M.S. (Guus) van Dongen; Marjolein Ankersmit; A. van Lingen; Danielle J. Vugts; Elisabeth Bloemena; Otto S. Hoekstra; H. J. Bonjer
- Source
- European Journal of Nuclear Medicine and Molecular Imaging, 46(7), 1495-1505. Springer Verlag
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 2019, ' Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer ', European Journal of Nuclear Medicine and Molecular Imaging, vol. 46, no. 7, pp. 1495-1505 . https://doi.org/10.1007/s00259-019-04284-w
European Journal of Nuclear Medicine and Molecular Imaging, 46, 7, pp. 1495-1505
European Journal of Nuclear Medicine and Molecular Imaging, 46, 1495-1505
European Journal of Nuclear Medicine and Molecular Imaging
- Subject
- Indocyanine Green
Male
PET/CT imaging
Colorectal cancer
Sentinel lymph node
Fluorescence
030218 nuclear medicine & medical imaging
03 medical and health sciences
chemistry.chemical_compound
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
SDG 3 - Good Health and Well-being
Positron Emission Tomography Computed Tomography
Preoperative Care
medicine
Humans
Radiology, Nuclear Medicine and imaging
Neoplasm Metastasis
Perioperative Period
Technetium Tc 99m Aggregated Albumin
Lymph node
Aged
Neoplasm Staging
PET-CT
Spectroscopy, Near-Infrared
business.industry
Cancer
General Medicine
Perioperative
Middle Aged
medicine.disease
Colon cancer
3. Good health
medicine.anatomical_structure
Near-infrared imaging
chemistry
Lymphatic Metastasis
Urological cancers Radboud Institute for Health Sciences [Radboudumc 15]
030220 oncology & carcinogenesis
Colonic Neoplasms
Original Article
Female
Lymph
Sentinel Lymph Node
business
Nuclear medicine
Indocyanine green
Lymphoscintigraphy
- Language
- English
- ISSN
- 1619-7070
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 [89Zr]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 [89Zr]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 [89Zr]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 specimen combined with intraoperative real-time NIR-imaging should be performed. Electronic supplementary material The online version of this article (10.1007/s00259-019-04284-w) contains supplementary material, which is available to authorized users.