Engels Svenja, Michalik Bianca, Dirks Lena, van Oosterom Matthias N, Wawroschek Friedhelm, Winter Alexander
University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany.
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Biomedicines. 2023 Oct 13;11(10):2779. doi: 10.3390/biomedicines11102779.
In prostate cancer, sentinel lymph node dissection (sLND) offers a personalized procedure with staging ability which is at least equivalent to extended LND while inducing lower morbidity. A bimodal fluorescent-radioactive approach was introduced to improve sentinel LN (SLN) detection. We present the first in-human case series on exploring the use of a fluorescent-magnetic hybrid tracer in a radiation-free sLND procedure. Superparamagnetic iron oxide nanoparticles and indocyanine green were administered simultaneously in five prostate cancer patients scheduled for extended LND, sLND and radical prostatectomy. In situ and ex vivo fluorescence and magnetic signals were documented for each LN sample detected via a laparoscopic fluorescence imaging and magnetometer system. Fluorescence and magnetic activity could be detected in all patients. Overall, 19 lymph node spots could be detected in situ, 14 of which were fluorescently active and 18 of which were magnetically active. In two patients, no fluorescent LNs could be detected in situ. The separation of the LN samples resulted in a total number of 30 SLNs resected. Ex vivo measurements confirmed fluorescence in all but two magnetically active SLNs. One LN detected in situ with both modalities was subsequently shown to contain a metastasis. This study provides the first promising results of a bimodal, radiation-free sLND, combining the advantages of both the magnetic and fluorescence approaches.
在前列腺癌中，前哨淋巴结清扫术（sLND）提供了一种个性化的手术方法，其分期能力至少与扩大淋巴结清扫术相当，同时发病率更低。引入了一种双模态荧光-放射性方法来改善前哨淋巴结（SLN）的检测。我们展示了首个关于在无辐射sLND手术中探索使用荧光-磁性混合示踪剂的人体病例系列。将超顺磁性氧化铁纳米颗粒和吲哚菁绿同时给予五名计划进行扩大淋巴结清扫术、sLND和根治性前列腺切除术的前列腺癌患者。通过腹腔镜荧光成像和磁力计系统对每个检测到的淋巴结样本记录原位和离体荧光及磁信号。所有患者均能检测到荧光和磁活性。总体而言，原位可检测到19个淋巴结点，其中14个具有荧光活性，18个具有磁活性。两名患者原位未检测到荧光淋巴结。淋巴结样本分离后共切除30个SLN。离体测量证实，除两个具有磁活性的SLN外，其他所有SLN均有荧光。通过两种方式原位检测到的一个淋巴结随后被证实含有转移灶。本研究提供了首个双模态、无辐射sLND的有前景结果，结合了磁性和荧光方法的优点。
