Authors: Nynke S van den Berg Oscar R Brouwer W Martin C Klop Bariş Karakullukcu Charlotte L Zuur I Bing Tan Alfons J M Balm Michiel W M van den Brekel Renato A Valdés Olmos Fijs W B van Leeuwen
Publish Date: 2012/04/18
Volume: 39, Issue: 7, Pages: 1128-1136
Abstract
For oral cavity malignancies sentinel lymph node SLN mapping is performed by injecting a radiocolloid around the primary tumour followed by lymphoscintigraphy Surgically SLNs can then be localized using a handheld gamma ray detection probe The aim of this study was to evaluate the added value of intraoperative fluorescence imaging to the conventional radioguided procedure For this we used indocyanine green ICG‐99mTc‐nanocolloid a hybrid tracer that is both radioactive and fluorescentFourteen patients with oral cavity squamous cell carcinoma were peritumourally injected with ICG99mTcnanocolloid SLNs were preoperatively identified with lymphoscintigraphy followed by single photon emission computed tomography SPECT/CT for anatomical localization During surgery SLNs were detected with a handheld gamma ray detection probe and a handheld nearinfrared fluorescence camera Preincision and postexcision imaging with a portable gamma camera was performed to confirm complete removal of all SLNsSLNs were preoperatively identified using the radioactive signature of ICG99mTcnanocolloid Intraoperatively 43 SLNs could be localized and excised with combined radio and fluorescence guidance Additionally in four patients an SLN located close to the primary injection site in three patients this SLN was located in level I could only be intraoperatively localized using fluorescence imaging Pathological analysis of the SLNs revealed a metastasis in one patientCombined preoperative SLN identification and intraoperative radio and fluorescence guidance during SLN biopsies for oral cavity cancer proved feasible using ICG99mTcnanocolloid The addition of fluorescence imaging was shown to be of particular value when SLNs were located in close proximity to the primary tumour
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