Van Den Berg N S, Buckle T, Kleinjan G I, Klop W M, Horenblas S, Van Der Poel H G, Valdés-Olmos R A, Van Leeuwen F I
Interventional Molecular Imaging Laboratory Department of Radiology Leiden University Medical Center, Leiden, The Netherlands -
Q J Nucl Med Mol Imaging. 2014 Jun;58(2):193-206.
Conventional sentinel node (SN) mapping is performed by injection of a radiocolloid followed by lymphoscintigraphy to identify the number and location of the primary tumor draining lymph node(s), the so-called SN(s). Over the last decade research has focused on the introduction of new imaging agents that can further aid (surgical) SN identification. Different tracers for SN mapping, with varying sizes and isotopes have been reported, most of which have proven their value in a clinical setting. A major challenge lies in transferring this diagnostic information obtained at the nuclear medicine department to the operating theatre thereby providing the surgeon with (image) guidance. Conventionally, an intraoperative injection of vital blue dye or a fluorescence dye is given to allow intraoperative optical SN identification. However, for some indications, the radiotracer-based approach remains crucial. More recently, hybrid tracers, that contain both a radioactive and fluorescent label, were introduced to allow for direct integration of pre- and intraoperative guidance technologies. Their potential is especially high when they are used in combination with new surgical imaging modalities and navigation tools. Next to a description of the known tracers for SN mapping, this review discusses the application of hybrid tracers during SN biopsy and how the introduction of these new techniques can further aid in translation of nuclear medicine information into the operating theatre.
传统的前哨淋巴结（SN）定位是通过注射放射性胶体，随后进行淋巴闪烁显像来确定原发肿瘤引流淋巴结（即所谓的前哨淋巴结）的数量和位置。在过去十年中，研究重点在于引入能够进一步辅助（手术）识别前哨淋巴结的新型显像剂。已报道了用于前哨淋巴结定位的不同示踪剂，其大小和同位素各异，其中大多数已在临床环境中证明了其价值。一个主要挑战在于将核医学科获得的诊断信息传递到手术室，从而为外科医生提供（图像）引导。传统上，术中注射活性蓝色染料或荧光染料以实现术中光学识别前哨淋巴结。然而，对于某些适应证，基于放射性示踪剂的方法仍然至关重要。最近，引入了同时含有放射性和荧光标记的混合示踪剂，以实现术前和术中引导技术的直接整合。当它们与新的手术成像模式和导航工具结合使用时，其潜力尤其巨大。除了描述已知的前哨淋巴结定位示踪剂外，本综述还讨论了混合示踪剂在前哨淋巴结活检中的应用，以及这些新技术的引入如何能够进一步辅助将核医学信息转化到手术室。
