Sentinel lymph node tumor burden quantified non-invasively and non-radioactively with multi-tracer and multispectral optoacoustic imaging

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Melanoma skin cancer is an aggressive and deadly tumor. According to the World Health Organization, the incidence of melanoma is increasing faster than any other major cancer in the world. Melanoma is the fifth most common cancer in Germany, posing a substantial health and economic burden. Melanoma metastasizes early into regional lymph nodes, requiring sentinel lymph node (SLN) histological status for prognostication and determination of patient survival. Sentinel lymph node excision (SLNE) is therefore recommended in the current 2009 AJCC guidelines. Widely used for decades, SLNE with histological analysis has proved to be effective and reliable, but it does have drawbacks. The gold standard for targeted extirpation of the SLN is lymphoscintigraphy using 99m-technetium (99mTc), which invariably represents a radioactive burden for patients and (to a lesser degree) caregivers. Furthermore there is a worldwide shortage of technetium-99m. SLNE is further a very cost-intensive intervention with potential morbidity, not found to improve overall patient survival. As only a portion of the node is sampled for histology, the optimal mode of pathological sectioning remains controversial and could in part explain the high false-negative rate of SLNE reported (9-44%). These drawbacks suggest that alternative strategies for SLN identification and diagnosis should be explored.In the proposed grant we will develop a new imaging approach which has the potential to quantify amelanotic and melanotic cancer cell burden in melanoma draining lymph nodes with high sensitivity and specificity. In the end we will have developed the first and only cost effective, noninvasive and nonradioactive approach for detecting microscopic levels of cancer cells in tumor draining lymph nodes. In the future this approach could also be applied to other solid tumors such as breast cancer where the economic and medical impact would be far greater.