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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-02-23

AUTHORS

M. Ankersmit, O. S. Hoekstra, A. van Lingen, E. Bloemena, M. A. J. M. Jacobs, D. J. Vugts, H. J. Bonjer, G. A. M. S. van Dongen, W. J. H. J. Meijerink

ABSTRACT

PurposeUsing 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.MethodsClinical 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.ResultsA 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.ConclusionsThis 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. More... »

PAGES

1495-1505

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00259-019-04284-w

DOI

http://dx.doi.org/10.1007/s00259-019-04284-w

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112360881

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30798428


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32 schema:description PurposeUsing 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.MethodsClinical 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.ResultsA 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.ConclusionsThis 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.
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39 schema:keywords CT
40 CT scan
41 ConclusionsThis study
42 NIR imaging
43 Nanocoll
44 PET/CT
45 PET/CT lymphoscintigraphy
46 PET/CT scans
47 ResultsA total
48 SLN
49 SLN identification
50 additional use
51 administration
52 cancer
53 cancer patients
54 colon cancer
55 colon cancer patients
56 conventional white light
57 early colon cancer
58 early colon cancer patients
59 examination
60 extensive pathological examination
61 feasibility
62 further research
63 green
64 identification
65 imaging
66 imaging modalities
67 imaging techniques
68 immunohistochemistry
69 indocyanine green
70 injection
71 intraoperative identification
72 intraoperative injection
73 layer
74 light
75 location
76 location of SLNs
77 lymph
78 lymph node identification
79 lymph node mapping
80 lymph nodes
81 lymphoscintigraphy
82 mapping
83 metastasis
84 modalities
85 needle positioning
86 node identification
87 node mapping
88 nodes
89 number
90 optical imaging techniques
91 pathological examination
92 patient injection
93 patients
94 positioning
95 postoperative scans
96 potential
97 preoperative PET/CT
98 preoperative PET/CT scan
99 preoperative lymphoscintigraphy
100 primary tumor
101 promising results
102 real-time NIR imaging
103 real-time visualization
104 research
105 results
106 scans
107 sentinel lymph
108 sentinel lymph node identification
109 sentinel lymph node mapping
110 specimen
111 study
112 submucosal injection
113 successful identification
114 successful injection
115 surgeons
116 surgery
117 technique
118 thick layer
119 tissue
120 total
121 tracer
122 tracer administration
123 tracer indocyanine green
124 tumors
125 types
126 types of cancer
127 use
128 visualization
129 vivo scans
130 white light
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