DE Vries Hielke Martijn, Schottelius Margret, Brouwer Oscar R, Buckle Tessa
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Q J Nucl Med Mol Imaging. 2021 Sep;65(3):261-270. doi: 10.23736/S1824-4785.21.03355-0. Epub 2021 May 31.
The increasing availability of new imaging technologies and tracers has enhanced the application of nuclear molecular imaging in urogenital interventions. In this context, preoperative nuclear imaging and radioactivity-based intraoperative surgical guidance have become important tools for the identification and anatomical allocation of tumor lesions and/or suspected lymph nodes. Fluorescence guidance can provide visual identification of the preoperatively defined lesions during surgery. However, the added value of fluorescence guidance is still mostly unknown. This review provides an overview of the role of fluorescence imaging in radioguided surgery in urogenital malignancies. The sentinel node (SN) biopsy procedure using hybrid tracers (radioactive and fluorescent component) serves as a prominent example for in-depth evaluation of the complementary value of radio- and fluorescence guidance. The first large patient cohort and long-term follow-up studies show: 1) improvement in the SN identification rate compared to blue dye; 2) improved detection of cancer-positive SNs; and 3) hints towards a positive effect on (biochemical) recurrence rates compared to extended lymph node dissection. The hybrid tracer approach also highlights the necessity of a preoperative roadmap in preventing incomplete resection. Recent developments focus on receptor-targeted approaches that allow intraoperative identification of tumor tissue. Here radioguidance is still leading, but fluorescent and hybrid tracers are also finding their way into the clinic. Emerging multiwavelength approaches that allow concomitant visualization of different anatomical features within the surgical field may provide the next step towards even more refined procedures.
新成像技术和示踪剂的可得性不断提高，增强了核分子成像在泌尿生殖系统干预中的应用。在此背景下，术前核成像和基于放射性的术中手术引导已成为识别肿瘤病变和/或可疑淋巴结并进行解剖定位的重要工具。荧光引导可在手术期间对术前确定的病变进行视觉识别。然而，荧光引导的附加价值大多仍不为人知。本综述概述了荧光成像在泌尿生殖系统恶性肿瘤放射性引导手术中的作用。使用混合示踪剂（放射性和荧光成分）的前哨淋巴结（SN）活检程序是深入评估放射性和荧光引导互补价值的一个突出例子。首批大型患者队列研究和长期随访研究表明：1）与蓝色染料相比，SN识别率有所提高；2）癌症阳性SN的检测得到改善；3）与扩大淋巴结清扫相比，对（生化）复发率有积极影响的迹象。混合示踪剂方法还凸显了术前路线图对防止切除不完全的必要性。近期的发展集中在受体靶向方法上，该方法可在术中识别肿瘤组织。在此，放射性引导仍然占主导地位，但荧光和混合示踪剂也正在进入临床。新兴的多波长方法可同时显示手术视野内的不同解剖特征，可能为实现更精细的手术迈出下一步。
