RT Journal Article
SR Electronic
T1 Robot-assisted hybrid sentinel node biopsy in prostate cancer patients: Towards improvement of fluorescence detection
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1671
OP 1671
VO 55
IS supplement 1
A1 Gijs KleinJan
A1 Nynke van den Berg
A1 Oscar Brouwer
A1 Renato Valdés Olmos
A1 Fijs Van Leeuwen
A1 Henk van der Poel
YR 2014
UL http://jnm.snmjournals.org/content/55/supplement_1/1671.abstract
AB 1671 Objectives The hybrid tracer (ICG-99mTc-nanocolloid) was successfully introduced to compliment intraoperative radioguidance towards the SNs with optical identification in various malignancies. However, in sophisticated procedures like laparoscopic robot-assisted radical prostatectomy (RARP) combined with SN biopsy, fluorescence-based SN detection might be further improved by optimizing tracer preparation, injection technique, and improving the near-infrared fluorescence laparoscope (KARL STORZ). Methods Between 2010 and 2013, 38 patients with a Briganti nomogram based risk >10% on lymph node metastasis were included for SN/RARP procedure. In group 1 (n=10) we used the previously published standard tracer preparation and the Tricam SL II + Storz D-light C system fluorescence laparoscope. In group 2 (n=12) we introduced a lower volume and a higher ICG concentration for the injection. In group 3 (n=16) we maintained the optimized tracer preparation and injection technique, but introduced an improved fluorescence laparoscope D-light P system with the Image HUB 1 HD. Results In group 1 a mean of 50% of the SNs could be optically visualized using fluorescence imaging. The altered hybrid tracer preparation and the injection technique resulted in a visualization rate of 64% in group 2. The introduction of the HD fluorescence laparoscope further increased the visualization rate to 93% in group 3. Although we showed a high fluorescence visualization rate in group 3, still the radioactive signal is necessary for the preoperative localization of the SNs using lymphoscintigraphy and SPECT/CT. ANOVA test showed a significant difference in the fluorescence visualization rate between the groups (p=0.008). Conclusions This study shows that adjustment of the hybrid SN technology significantly improved the in vivo fluorescence detection during RARP Research Support This work was partially supported by a Dutch Cancer Society translational research award (Grant No. PGF 2009-4344), an NWO-STW-VIDI grant (Grant No. STW BGT11272) and an ERC-starting grant (Grant No. 2012-306890). Karl Storz endoscopes supported this research with Tricam SL II + Storz D-light C system fluorescence laparoscope and a D-light P system with the Image HUB 1 HD fluorescence laparoscope