Metastatic status of sentinel lymph nodes in melanoma determined noninvasively with multispectral optoacoustic imaging
Metastatic status of sentinel lymph nodes in melanoma determined noninvasively with multispectral optoacoustic imaging
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DOI：
10.1126/scitranslmed.aad1278
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发表时间：
2015-12-09
影响因子：
17.1
通讯作者：
Klode, Joachim
中科院分区：
文献类型：
--
作者：
Stoffels, Ingo;Morscher, Stefan;Klode, Joachim
前哨淋巴结（SLN）切除包括在各种癌症指南中，以识别显微镜下转移性疾病。虽然SLN切除是有效的，但它是一种需要放射性示踪的侵入性手术。新的影像学方法评估SLN转移状态可以改善或取代传统的淋巴结切除方案。在我们的首次人体研究中，我们使用非侵入性多光谱光声断层扫描（MSOT）成像SLN离体和体内黑色素瘤患者，以确定转移状态。与传统EORTC（欧洲癌症研究与治疗组织）黑色素瘤组方案相比，MSOT显著提高了切除的SLN（来自214名黑色素瘤患者的506个SLN）中的肿瘤转移检测率（22.9% vs 14.2%）。MSOT结合近红外荧光团吲哚菁绿色在20例患者体内可靠地显示了SLN，穿透深度达5 cm，与Tc-99 m标记的SLN淋巴结造影100%一致。MSOT在体内和离体无一例假阴性（189个淋巴结）的情况下鉴定了无癌SLN，灵敏度为100%，特异性为48 - 62%。我们的研究结果表明，一个非侵入性，非放射性MSOT为基础的方法可以识别和确定SLN的状态，并有信心地排除转移的存在。该研究进一步表明，光声成像策略可以改善SLN转移的识别，作为当前侵入性SLN切除方案的替代方案。
Sentinel lymph node (SLN) excision is included in various cancer guidelines to identify microscopic metastatic disease. Although effective, SLN excision is an invasive procedure requiring radioactive tracing. Novel imaging approaches assessing SLN metastatic status could improve or replace conventional lymph node excision protocols. In our first-in- human study, we used noninvasive multispectral optoacoustic tomography (MSOT) to image SLNs ex vivo and in vivo in patients with melanoma, to determine metastatic status. MSOT significantly improved the tumor metastasis detection rate in excised SLN (506 SLNs from 214 melanoma patients) compared with the conventional EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group protocol (22.9% versus 14.2%). MSOT combined with the near-infrared fluorophore indocyanine green reliably visualized SLNs in vivo in 20 patients, up to 5-cm penetration and with 100% concordance with Tc-99m-marked SLN lymphoscintigraphy. MSOT identified cancer-free SLNs in vivo and ex vivo without a single false negative (189 total lymph nodes), with 100% sensitivity and 48 to 62% specificity. Our findings indicate that a noninvasive, nonradioactive MSOT-based approach can identify and determine SLN status and confidently rule out the presence of metastasis. The study further demonstrates that optoacoustic imaging strategies can improve the identification of SLN metastasis as an alternative to current invasive SLN excision protocols.