Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Nucl Med. 2012 Jul;53(7):1026-33. doi: 10.2967/jnumed.111.098517. Epub 2012 May 29.
Intraprostatic injection of the hybrid tracer indocyanine green (ICG)-(99m)Tc-nanocolloid enables both preoperative sentinel node (SN) identification and intraoperative visualization of the SN. Relating the fluorescence deposits in embedded prostate tissue specimens to the preoperatively detected SNs also provides the opportunity to study the influence of their placement on lymphatic drainage pattern.
Nineteen patients with prostate carcinoma scheduled for robot-assisted laparoscopic prostatectomy and lymph node (LN) dissection were included. ICG-(99m)Tc-nanocolloid was injected intraprostatically, guided by ultrasound. SN biopsy was performed using a combination of radioguidance and fluorescence guidance. Tracer distribution was visualized in paraffin-embedded prostate samples using ex vivo fluorescence imaging. This distribution was correlated to the number and location of the SNs identified on preoperative lymphoscintigraphy and SPECT/CT.
ICG-(99m)Tc-nanocolloid helped guide surgical excision of the SNs. Ex vivo fluorescence imaging revealed a large variation in the locations of intraprostatic tracer deposits among patients. Tracer deposits in the peripheral zone correlated with a higher number of visualized LNs than deposits in the central zone (on average, 4.7 vs. 2.4 LNs per patient). Furthermore, tracer deposits in the mid gland correlated with a higher number of visualized LNs than deposits near the base or apex of the prostate (on average, 6 vs. 3.5 LNs per patient).
The hybrid nature of the tracer not only enables surgical guidance but also provides an opportunity to study the correlation between the location of tracer deposits within the prostate and the number and location of preoperatively visualized SNs. These data suggest that the location at which a tracer deposit is placed influences the lymphatic drainage pattern.
经直肠内注射混合示踪剂吲哚菁绿（ICG）-（99m）Tc-纳米胶体，实现术前前哨淋巴结（SN）识别和术中 SN 可视化。将嵌入前列腺组织标本中的荧光沉积物与术前检测到的 SN 相关联，也为研究它们的放置位置对淋巴引流模式的影响提供了机会。
纳入 19 例计划接受机器人辅助腹腔镜前列腺切除术和淋巴结（LN）清扫术的前列腺癌患者。ICG-（99m）Tc-纳米胶体在超声引导下经直肠内注射。使用放射性引导和荧光引导相结合的方法进行 SN 活检。使用离体荧光成像技术观察示踪剂在石蜡包埋前列腺样本中的分布。这种分布与术前淋巴闪烁显像和 SPECT/CT 识别的 SN 数量和位置相关联。
ICG-（99m）Tc-纳米胶体有助于指导 SN 的外科切除。离体荧光成像显示，患者之间的前列腺内示踪剂沉积位置存在很大差异。外周带的示踪剂沉积与更多可见 LN 的数量相关，而中央带的示踪剂沉积与更多可见 LN 的数量相关（平均每个患者分别为 4.7 和 2.4 个 LN）。此外，中腺的示踪剂沉积与更多可见 LN 的数量相关，而前列腺基部或尖部附近的示踪剂沉积与更多可见 LN 的数量相关（平均每个患者分别为 6 和 3.5 个 LN）。
该示踪剂的混合性质不仅使外科手术具有指导意义，而且还为研究前列腺内示踪剂沉积位置与术前可视化 SN 数量和位置之间的相关性提供了机会。这些数据表明，示踪剂沉积的位置影响淋巴引流模式。
