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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2016

Open Access 01-08-2016 | Head and Neck Oncology

(Near-Infrared) Fluorescence-Guided Surgery Under Ambient Light Conditions: A Next Step to Embedment of the Technology in Clinical Routine

Authors: Nynke S. van den Berg, MSc, Mitsuharu Miwa, BE, Gijs H. KleinJan, MD, Takayuki Sato, BE, Yoshiki Maeda, BE, Alexander C. J. van Akkooi, MD, PhD, Simon Horenblas, MD, PhD, Baris Karakullukcu, MD, PhD, Fijs W. B. van Leeuwen, PhD

Published in: Annals of Surgical Oncology | Issue 8/2016

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Abstract

Background and Purpose

In open surgery procedures, after temporarily dimming the lights in the operation theatre, the Photo Dynamic Eye (PDE) fluorescence camera has, amongst others, been used for fluorescence-guided sentinel node (SN) biopsy procedures. To improve the clinical utility and logistics of fluorescence-guided surgery, we developed and evaluated a prototype modified PDE (m-PDE) fluorescence camera system.

Methods

The m-PDE works under ambient light conditions and includes a white light mode and a pseudo-green-colored fluorescence mode (including a gray-scaled anatomical background). Twenty-seven patients scheduled for SN biopsy for (head and neck) melanoma (n = 16), oral cavity (n = 6), or penile (n = 5) cancer were included. The number and location of SNs were determined following an indocyanine green-99mTc-nanocolloid injection and preoperative imaging. Intraoperatively, fluorescence guidance was used to visualize the SNs. The m-PDE and conventional PDE were compared head-to-head in a phantom study, and in seven patients. In the remaining 20 patients, only the m-PDE was evaluated.

Results

Phantom study: The m-PDE was superior over the conventional PDE, with a detection sensitivity of 1.20 × 10−11 M (vs. 3.08 × 10−9 M) ICG in human serum albumin. In the head-to-head clinical comparison (n = 7), the m-PDE was also superior: (i) SN visualization: 100 versus 81.4 %; (ii) transcutaneous SN visualization: 40.7 versus 22.2 %; and (iii) lymphatic duct visualization: 7.4 versus 0 %. Findings were further underlined in the 20 additionally included patients.

Conclusion

The m-PDE enhanced fluorescence imaging properties compared with its predecessor, and provides a next step towards routine integration of real-time fluorescence guidance in open surgery.
Appendix
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Metadata
Title
(Near-Infrared) Fluorescence-Guided Surgery Under Ambient Light Conditions: A Next Step to Embedment of the Technology in Clinical Routine
Authors
Nynke S. van den Berg, MSc
Mitsuharu Miwa, BE
Gijs H. KleinJan, MD
Takayuki Sato, BE
Yoshiki Maeda, BE
Alexander C. J. van Akkooi, MD, PhD
Simon Horenblas, MD, PhD
Baris Karakullukcu, MD, PhD
Fijs W. B. van Leeuwen, PhD
Publication date
01-08-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5186-3

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