Chand Manish, Keller Deborah S, Devoto Laurence, McGurk Mark
Department of Surgery and Interventional Sciences, University College London Hospitals, NHS Trusts, GENIE Centre, University College London, 235 Euston Rd, NW1 2BU, London, UK.
Head and Neck Centre, University College London Hospitals, NHS Trusts, London, UK.
J Fluoresc. 2018 Mar;28(2):483-486. doi: 10.1007/s10895-018-2211-x. Epub 2018 Jan 22.
To describe an innovative sentinel lymph node (SLN) guidance approach using a radionuclide tracer, 3D augmented reality-guided imaging, and near infrared (NIR) fluorescence over-lay imaging with hand-held probes to optimize accuracy, efficiency, and precise navigation for sentinel node (SN) localization in head and neck cancer. In a cT1N0M0 squamous cell carcinoma of the tongue, pre-operative radionuclide lymphoscintigraphy was performed with a sentinel node-specific radiolabeled tracer. Intraoperatively, a 3D hand-held augmented reality (AR) scanning SPECT probe assessed concordance of the SN with pre-operative SPECT-CT images. The real-time optical video was linked to the SPECT-CT images for added precision. Final guidance to the SN was performed using ICG fluorescence imaging. Dynamic and SPECT-CT showed bilateral lymphatic drainage from the tumor. The 3D hand-held AR SPECT probe SN localization was concordant with pre-operative imaging. The optical video successfully demonstrated the lymphatic drainage in real-time through a unique overlay fluorescence image. The ICG localized to the same nodes identified by both the SPECT-CT and hand-held SPECT images. The use of dual radiation and fluorescence tracers improved SN detection, especially for SN close to the injection site. The hand-held probes allowed the surgeon to dissect continuously, without needing to change tools. The combination of augmented reality, nuclear medicine, and over-lay fluorescence imaging allowed greater accuracy for matching the preoperative imaging with intraoperative identification and precisely guiding the dissection. This method uniquely permitted the surgeon to efficiently dissect the SN with accurate visualization and optimal precision.
描述一种创新的前哨淋巴结（SLN）引导方法，该方法使用放射性核素示踪剂、3D增强现实引导成像以及带有手持探头的近红外（NIR）荧光叠加成像，以优化头颈部癌前哨淋巴结（SN）定位的准确性、效率和精确导航。在一例舌部cT1N0M0鳞状细胞癌中，术前使用前哨淋巴结特异性放射性标记示踪剂进行放射性核素淋巴闪烁显像。术中，使用3D手持增强现实（AR）扫描SPECT探头评估SN与术前SPECT-CT图像的一致性。实时光学视频与SPECT-CT图像相连以提高精度。使用吲哚菁绿（ICG）荧光成像对SN进行最终引导。动态成像和SPECT-CT显示肿瘤有双侧淋巴引流。3D手持AR SPECT探头对SN的定位与术前成像一致。光学视频通过独特的叠加荧光图像成功实时显示了淋巴引流情况。ICG定位到SPECT-CT和手持SPECT图像均识别出的相同淋巴结。使用双辐射和荧光示踪剂提高了SN的检测率，尤其是对于靠近注射部位的SN。手持探头使外科医生能够持续进行解剖，而无需更换工具。增强现实、核医学和叠加荧光成像的结合使得术前成像与术中识别的匹配以及精确引导解剖具有更高的准确性。这种方法独特地使外科医生能够在准确可视化和最佳精度的情况下高效地解剖SN。
