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Open Access 01-06-2012 | Head and Neck Oncology

Feasibility of Sentinel Node Biopsy in Head and Neck Melanoma Using a Hybrid Radioactive and Fluorescent Tracer

Authors: Oscar R. Brouwer, MD, W. Martin C. Klop, MD, Tessa Buckle, MSc, Lenka Vermeeren, MD, Michiel W. M. van den Brekel, MD, Alfons J. M. Balm, MD, Omgo E. Nieweg, MD, Renato A. Valdés Olmos, MD, Fijs W. B. van Leeuwen, PhD

Published in: Annals of Surgical Oncology | Issue 6/2012

Abstract

Purpose

This study was designed to examine the feasibility of combining lymphoscintigraphy and intraoperative sentinel node identification in patients with head and neck melanoma by using a hybrid protein colloid that is both radioactive and fluorescent.

Methods

Eleven patients scheduled for sentinel node biopsy in the head and neck region were studied. Approximately 5 h before surgery, the hybrid nanocolloid labeled with indocyanine green (ICG) and technetium-99m (^99mTc) was injected intradermally in four deposits around the scar of the primary melanoma excision. Subsequent lymphoscintigraphy and single photon emission computed tomography with computed tomography (SPECT/CT) were performed to identify the sentinel nodes preoperatively. In the operating room, patent blue dye was injected in 7 of the 11 patients. Intraoperatively, sentinel nodes were acoustically localized with a gamma ray detection probe and visualized by using patent blue dye and/or fluorescence-based tracing with a dedicated near-infrared light camera. A portable gamma camera was used before and after sentinel node excision to confirm excision of all sentinel nodes.

Results

A total of 27 sentinel nodes were preoperatively identified on the lymphoscintigraphy and SPECT/CT images. All sentinel nodes could be localized intraoperatively. In the seven patients in whom blue dye was used, 43% of the sentinel nodes stained blue, whereas all were fluorescent. The portable gamma camera identified additional sentinel nodes in two patients. Ex vivo, all radioactive lymph nodes were fluorescent and vice versa, indicating the stability of the hybrid tracer.

Conclusions

ICG–^99mTc-nanocolloid allows for preoperative sentinel node visualization and concomitant intraoperative radio- and fluorescence guidance to the same sentinel nodes in head and neck melanoma patients.

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Title: Feasibility of Sentinel Node Biopsy in Head and Neck Melanoma Using a Hybrid Radioactive and Fluorescent Tracer
Authors: Oscar R. Brouwer, MD
W. Martin C. Klop, MD
Tessa Buckle, MSc
Lenka Vermeeren, MD
Michiel W. M. van den Brekel, MD
Alfons J. M. Balm, MD
Omgo E. Nieweg, MD
Renato A. Valdés Olmos, MD
Fijs W. B. van Leeuwen, PhD
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-2180-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility of Sentinel Node Biopsy in Head and Neck Melanoma Using a Hybrid Radioactive and Fluorescent Tracer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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