Feasibility of Sentinel Node Biopsy in Head and Neck Melanoma Using a Hybrid Radioactive and Fluorescent Tracer
Feasibility of Sentinel Node Biopsy in Head and Neck Melanoma Using a Hybrid Radioactive and Fluorescent Tracer
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DOI：
10.1245/s10434-011-2180-7
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发表时间：
2012-06-01
影响因子：
3.7
通讯作者：
van Leeuwen, Fijs W. B.
中科院分区：
文献类型：
--
作者：
Brouwer, Oscar R.;Klop, W. Martin C.;van Leeuwen, Fijs W. B.
本研究的目的是探讨淋巴结造影术和术中前哨淋巴结识别头颈部黑色素瘤患者的可行性，通过使用混合蛋白胶体，这是既放射性和荧光。手术前约5小时，将吲哚菁绿色（ICG）和锝-99 m（Tc-99 m）标记的混合纳米胶体皮内注射到原发性黑色素瘤切除瘢痕周围的四个沉积物中。随后进行淋巴结造影和单光子发射计算机断层扫描与计算机断层扫描（SPECT/CT），以确定前哨淋巴结术前。在手术室中，11名患者中有7名注射了专利蓝染料。术中，前哨淋巴结声学定位与伽马射线探测探头和可视化使用专利蓝染料和/或荧光为基础的跟踪与专用的近红外光相机。在前哨淋巴结切除前后使用便携式伽玛射线照相机确认所有前哨淋巴结切除，术前在淋巴结造影和SPECT/CT图像上共识别出27个前哨淋巴结。所有前哨淋巴结都可以在术中定位。在使用蓝色染料的7名患者中，43%的前哨淋巴结染成蓝色，而所有的都是荧光。便携式伽玛相机确定了额外的前哨淋巴结在两名患者。离体，所有放射性淋巴结都是荧光的，反之亦然，表明混合示踪剂的稳定性ICG-Tc-99 m-纳米胶体允许术前前哨淋巴结可视化和伴随的术中放射性和荧光引导到头颈部黑色素瘤患者的相同前哨淋巴结。
This study was designed to examine the feasibility of combining lymphoscintigraphy and intraoperative sentinel node identification in patients with head and neck melanoma by using a hybrid protein colloid that is both radioactive and fluorescent.Eleven patients scheduled for sentinel node biopsy in the head and neck region were studied. Approximately 5 h before surgery, the hybrid nanocolloid labeled with indocyanine green (ICG) and technetium-99m (Tc-99m) was injected intradermally in four deposits around the scar of the primary melanoma excision. Subsequent lymphoscintigraphy and single photon emission computed tomography with computed tomography (SPECT/CT) were performed to identify the sentinel nodes preoperatively. In the operating room, patent blue dye was injected in 7 of the 11 patients. Intraoperatively, sentinel nodes were acoustically localized with a gamma ray detection probe and visualized by using patent blue dye and/or fluorescence-based tracing with a dedicated near-infrared light camera. A portable gamma camera was used before and after sentinel node excision to confirm excision of all sentinel nodes.A total of 27 sentinel nodes were preoperatively identified on the lymphoscintigraphy and SPECT/CT images. All sentinel nodes could be localized intraoperatively. In the seven patients in whom blue dye was used, 43% of the sentinel nodes stained blue, whereas all were fluorescent. The portable gamma camera identified additional sentinel nodes in two patients. Ex vivo, all radioactive lymph nodes were fluorescent and vice versa, indicating the stability of the hybrid tracer.ICG-Tc-99m-nanocolloid allows for preoperative sentinel node visualization and concomitant intraoperative radio- and fluorescence guidance to the same sentinel nodes in head and neck melanoma patients.