Real-time sentinel lymph node biopsy guidance using combined ultrasound, photoacoustic, fluorescence imaging: in vivo proof-of-principle and validation with nodal obstruction.
Real-time sentinel lymph node biopsy guidance using combined ultrasound, photoacoustic, fluorescence imaging: in vivo proof-of-principle and validation with nodal obstruction.
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DOI：
10.1038/srep45008
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发表时间：
2017-03-22
影响因子：
4.6
通讯作者：
Song TK
中科院分区：
文献类型：
--
作者：
Kang J;Chang JH;Kim SM;Lee HJ;Kim H;Wilson BC;Song TK
精确的前哨淋巴结（SLN）识别不仅对于在癌症进展的早期准确诊断微转移至关重要，而且对于减少SLN活检（SLNB）的数量以最大限度地减少其严重副作用也至关重要。此外，期望SLNB引导在常规临床使用中尽可能安全。尽管目前有各种SLNB引导方法用于术前或术中评估，但没有一种是理想的。我们提出了一种使用对比度增强的三模态图像（即，超声波、光声和荧光）。三模态成像的主要优势在这里通过在体内研究的技术困难的情况下，淋巴结阻塞，经常导致患者的假阴性结果证明。在兔和正常对照的肿瘤模型中的结果表明，三模式成像能够清楚地识别阻塞的SLN，并指示其转移参与。基于这些发现，我们提出了一个SLNB协议，以帮助外科医生充分利用从三模态成像获得的互补信息，包括术前定位，术中活检指导和术后分析。
Precise sentinel lymph node (SLN) identification is crucial not only for accurate diagnosis of micro-metastases at an early stage of cancer progression but also for reducing the number of SLN biopsies (SLNB) to minimize their severe side effects. Furthermore, it is desirable that an SLNB guidance should be as safe as possible in routine clinical use. Although there are currently various SLNB guidance methods for pre-operative or intra-operative assessment, none are ideal. We propose a real-time SLNB guidance method using contrast-enhanced tri-modal images (i.e., ultrasound, photoacoustic, and fluorescence) acquired by a recently developed hand-held tri-modal probe. The major advantage of tri-modal imaging is demonstrated here through an in vivo study of the technically-difficult case of nodal obstruction that frequently leads to false-negative results in patients. The results in a tumor model in rabbits and normal controls showed that tri-modal imaging is capable of clearly identifying obstructed SLNs and of indicating their metastatic involvement. Based on these findings, we propose an SLNB protocol to help surgeons take full advantage of the complementary information obtained from tri-modal imaging, including for pre-operative localization, intra-operative biopsy guidance and post-operative analysis.