Phillipa Meershoek1, Tessa Buckle1,2, Matthias N van Oosterom1,2, Gijs H KleinJan1,2, Henk G van der Poel2, Fijs W B van Leeuwen3,2. 1. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; and. 2. Department of Urology, Netherlands Cancer Center and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 3. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; and f.w.b.van_leeuwen@lumc.nl.
Abstract
Tracers can help visualize the lymphatic drainage patterns and sentinel nodes (SNs) of individual prostate cancer patients. To determine the role of nuclear medicine in surgical guidance, in particular the positional guidance of a SPECT/CT-based 3-dimensional imaging road map, in this process we studied to what extent fluorescence guidance underestimated the number of target lesions relative to radioguidance. Methods: SPECT/CT imaging was performed after intraprostatic tracer administration of either indocyanine green (ICG)-99mTc-nanocolloid (hybrid-tracer group) or 99mTc-nanocolloid to create a road map that depicted all SNs. Patients who received 99mTc-nanocolloid were injected with "free" ICG immediately before surgery. Before unmasking, fluorescence guidance was used for intraoperative SN identification. This was followed by extended pelvic lymph node dissection (ePLND). After unmasking of the SPECT/CT images, the number of missed SNs was recorded and their resection was pursued when there was no risk of intraoperative complications. Results: Preoperative SPECT/CT revealed no differences in the SN identification rate between ICG-99mTc-nanocolloid and 99mTc-nanocolloid. However, fluorescence guidance allowed intraoperative removal of all SNs in only 40% of patients in the hybrid-tracer group and 20% of patients in the free-ICG group. Overall, 75.9% of the intraoperatively resected SNs in the hybrid-tracer group and 51.8% of the SNs in the free-ICG group were removed solely under fluorescence guidance. During ePLND, 22 additional SNs were resected (7 in the hybrid-tracer group and 15 in the free-ICG group). After unmasking, 18 remaining SNs were identified (6 in the hybrid group and 12 in the free-ICG group). In the free-ICG group, ex vivo evaluation of the excised specimens revealed that 14 SNs removed under ePLND or after unmasking contained radioactivity but no fluorescence. Conclusion: The preoperative imaging road map provided by SPECT/CT enhanced the detection of prostate SNs in more ectopic locations in 17 of the 25 patients, and the hybrid tracer ICG-99mTc-nanocolloid was shown to outperform free ICG. Overall, fluorescence-guided pelvic nodal surgery underestimated the number of SNs in 60%-80% of patients.
Tracers can help visualize the lymphatic drainage patterns and sentinel nodes (SNs) of individual prostate cancerpatients. To determine the role of nuclear medicine in surgical guidance, in particular the positional guidance of a SPECT/CT-based 3-dimensional imaging road map, in this process we studied to what extent fluorescence guidance underestimated the number of target lesions relative to radioguidance. Methods: SPECT/CT imaging was performed after intraprostatic tracer administration of either indocyanine green (ICG)-99mTc-nanocolloid (hybrid-tracer group) or 99mTc-nanocolloid to create a road map that depicted all SNs. Patients who received 99mTc-nanocolloid were injected with "free" ICG immediately before surgery. Before unmasking, fluorescence guidance was used for intraoperative SN identification. This was followed by extended pelvic lymph node dissection (ePLND). After unmasking of the SPECT/CT images, the number of missed SNs was recorded and their resection was pursued when there was no risk of intraoperative complications. Results: Preoperative SPECT/CT revealed no differences in the SN identification rate between ICG-99mTc-nanocolloid and 99mTc-nanocolloid. However, fluorescence guidance allowed intraoperative removal of all SNs in only 40% of patients in the hybrid-tracer group and 20% of patients in the free-ICG group. Overall, 75.9% of the intraoperatively resected SNs in the hybrid-tracer group and 51.8% of the SNs in the free-ICG group were removed solely under fluorescence guidance. During ePLND, 22 additional SNs were resected (7 in the hybrid-tracer group and 15 in the free-ICG group). After unmasking, 18 remaining SNs were identified (6 in the hybrid group and 12 in the free-ICG group). In the free-ICG group, ex vivo evaluation of the excised specimens revealed that 14 SNs removed under ePLND or after unmasking contained radioactivity but no fluorescence. Conclusion: The preoperative imaging road map provided by SPECT/CT enhanced the detection of prostate SNs in more ectopic locations in 17 of the 25 patients, and the hybrid tracer ICG-99mTc-nanocolloid was shown to outperform free ICG. Overall, fluorescence-guided pelvic nodal surgery underestimated the number of SNs in 60%-80% of patients.
Authors: Samaneh Azargoshasb; Imke Boekestijn; Meta Roestenberg; Gijs H KleinJan; Jos A van der Hage; Henk G van der Poel; Daphne D D Rietbergen; Matthias N van Oosterom; Fijs W B van Leeuwen Journal: Mol Imaging Biol Date: 2022-06-16 Impact factor: 3.488
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Authors: Imke Boekestijn; Matthias N van Oosterom; Paolo Dell'Oglio; Floris H P van Velden; Martin Pool; Tobias Maurer; Daphne D D Rietbergen; Tessa Buckle; Fijs W B van Leeuwen Journal: Cancer Imaging Date: 2022-09-06 Impact factor: 5.605
Authors: Samaneh Azargoshasb; Lennert Molenaar; Giuseppe Rosiello; Tessa Buckle; Danny M van Willigen; Melissa M van de Loosdrecht; Mick M Welling; Lejla Alic; Fijs W B van Leeuwen; Alexander Winter; Matthias N van Oosterom Journal: Int J Comput Assist Radiol Surg Date: 2021-07-31 Impact factor: 2.924