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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2016

Open Access 01-02-2016 | Head and Neck Oncology

Feasibility of Real-Time Near-Infrared Fluorescence Tracer Imaging in Sentinel Node Biopsy for Oral Cavity Cancer Patients

Authors: Anders Christensen, MD, Karina Juhl, MSc, Birgitte Charabi, MD, Jann Mortensen, MD, DMSc, Katalin Kiss, MD, Andreas Kjær, MD, PhD, DMSc, Christian von Buchwald, MD, DMSc

Published in: Annals of Surgical Oncology | Issue 2/2016

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Abstract

Background

Sentinel node biopsy (SNB) is an established method in oral squamous cell carcinoma (OSCC) for staging the cN0 neck and to select patients who will benefit from a neck dissection. Near-infrared fluorescence (NIRF) imaging has the potential to improve the SNB procedure by facilitating intraoperative visual identification of the sentinel lymph node (SN). The purpose of this study was to evaluate the feasibility of fluorescence tracer imaging for SN detection in conjunction with conventional radio-guided technique.

Methods

Prospective study of patients with primary OSCC planned for tumor resection and SNB. Thirty patients were injected peritumorally with a bimodal tracer (ICG-99mTc-Nanocoll) followed by lymphoscintigraphy and SPECT/CT to define the SNs and their anatomical location preoperatively. SNs were detected intraoperatively with a hand-held gamma-probe and a hand-held NIRF camera.

Results

In 29 of 30 subjects (97%), all preoperatively defined SNs could be identified intraoperatively using a combination of radioactive and fluorescence guidance. A total of 94 SNs (mean 3, range 1–5) that were both radioactive and fluorescent ex vivo were harvested. Eleven of 94 SNs (12%) could only be identified in vivo using NIRF imaging, and the majority of those were located in level 1 close to the primary tumor.

Conclusions

A combined fluorescent and radioactive tracer for SNB is feasible, and the additional use of NIRF imaging may improve the accuracy of SN identification in oral cancer patients. Intraoperative fluorescence guidance seems of particular value when SNs are located in close proximity to the injection site.
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Metadata
Title
Feasibility of Real-Time Near-Infrared Fluorescence Tracer Imaging in Sentinel Node Biopsy for Oral Cavity Cancer Patients
Authors
Anders Christensen, MD
Karina Juhl, MSc
Birgitte Charabi, MD
Jann Mortensen, MD, DMSc
Katalin Kiss, MD
Andreas Kjær, MD, PhD, DMSc
Christian von Buchwald, MD, DMSc
Publication date
01-02-2016
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 2/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4883-7

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