一种新型的使用磁性和荧光混合示踪剂的前列腺癌前哨淋巴结成像双模态方法。
A new bimodal approach for sentinel lymph node imaging in prostate cancer using a magnetic and fluorescent hybrid tracer.
机构信息
University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.
University Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.
出版信息
Eur J Nucl Med Mol Imaging. 2024 Aug;51(10):2922-2928. doi: 10.1007/s00259-023-06522-8. Epub 2023 Nov 24.
PURPOSE
To obtain initial data on sentinel lymph node (SLN) visualisation by pre-operative magnetic resonance imaging (MRI) and intra-operative bimodal SLN identification using a new magnetic fluorescent hybrid tracer in prostate cancer (PCa) patients.
METHODS
Ten patients at > 5% risk for lymph node (LN) invasion were included. The day before surgery, a magnetic fluorescent hybrid tracer consisting of superparamagnetic iron oxide nanoparticles (SPION) and indocyanine green was transrectally injected into the prostate. Five hours after injection, transversal pelvic MRI scans were recorded and T2*-weighed images were screened for pelvic LNs with SPION uptake. Intra-operatively, magnetically active and/or fluorescent SLNs were detected by a handheld magnetometer and near-infrared fluorescence imaging (FI). Extended pelvic lymph node dissection (PLND) and radical prostatectomy completed the surgery. All resected specimens were checked ex situ for magnetic activity and fluorescence and were histopathologically examined.
RESULTS
Pre-operative MRI identified 145 pelvic LNs with SPION uptake. In total, 75 (median 6, range 3‒13) magnetically active SLNs were resected, including 14 SLNs not seen on MRI. FI identified 89 fluorescent LNs (median 8.5, range 4‒13) of which 15 LNs were not magnetically active. Concordance of the different techniques was 70% for pre-operative MRI vs. magnetometer-guided PLND and 88% for magnetic vs. fluorescent SLN detection.
CONCLUSION
These are the first promising results of bimodal, magnetic fluorescent SLN detection in PCa patients. Our magnetic fluorescent hybrid approach provides the surgeon a pre-operative lymphatic roadmap by using MRI and intra-operative visual guidance through the application of a fluorescent lymphatic agent. The diagnostic accuracy of our new hybrid approach has to be evaluated in further studies.
TRIAL REGISTRATION
DRKS00032808. Registered 04 October 2023, retrospectively registered.
目的
在前列腺癌（PCa）患者中，通过术前磁共振成像（MRI）获得前哨淋巴结（SLN）可视化的初始数据，并使用新型磁性荧光混合示踪剂进行术中双模式 SLN 识别。
方法
纳入 10 名存在淋巴结（LN）侵犯风险>5%的患者。手术前一天，经直肠将由超顺磁性氧化铁纳米颗粒（SPION）和吲哚菁绿组成的磁性荧光混合示踪剂注入前列腺。注射后 5 小时，记录横向骨盆 MRI 扫描，并对骨盆 LN 摄取 SPION 的 T2*-加权图像进行筛查。术中，使用手持式磁强计和近红外荧光成像（FI）检测磁性活性和/或荧光 SLN。扩展的骨盆淋巴结清扫术（PLND）和根治性前列腺切除术完成手术。所有切除标本均进行离体磁性活性和荧光检查，并进行组织病理学检查。
结果
术前 MRI 识别出 145 个具有 SPION 摄取的骨盆 LN。共切除 75 个（中位数 6 个，范围 3-13 个）磁性活性 SLN，包括 14 个 MRI 上未见的 SLN。FI 共识别出 89 个荧光 LN（中位数 8.5 个，范围 4-13 个），其中 15 个 LN 不具有磁性活性。不同技术的一致性为术前 MRI 与磁强计引导的 PLND 为 70%，磁性与荧光 SLN 检测为 88%。
结论
这些是首例在前列腺癌患者中进行双模式磁性荧光 SLN 检测的有前景的结果。我们的磁性荧光混合方法通过使用 MRI 提供术前淋巴路径图，并通过应用荧光淋巴示踪剂进行术中可视化指导，为外科医生提供了帮助。我们的新型混合方法的诊断准确性需要在进一步的研究中进行评估。
试验注册
DRKS00032808。2023 年 10 月 4 日注册，回顾性注册。
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