Michalik Bianca, Engels Svenja, Otterbach Maximilian C, Maurer Martin H, 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, 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.
Front Oncol. 2025 May 9;15:1523038. doi: 10.3389/fonc.2025.1523038. eCollection 2025.
Invasive lymph node (LN) staging is crucial for survival in penile cancer (PeCa) patients. To lower patient morbidity associated with radical inguinal lymphadenectomy, sentinel node biopsy (SNB) is recommended. Application of conventional radioactive/fluorescent tracers for sentinel node (SN) labelling is limited to centers with nuclear medicine or lacks pre-operative imaging. We introduce a radiation-free fluorescent magnetic hybrid tracer for bimodal inguinal SN imaging in PeCa patients. In three consecutive PeCa patients, the fluorescent magnetic hybrid tracer (50 µl indocyanine green, 5 mg/ml, in 1 ml superparamagnetic iron oxide nanoparticles) was peritumorally injected. SNs were visualized by magnetic resonance imaging (MRI). Intra-operatively, SNs were detected using a handheld magnetometer and a fluorescence camera. Concordance was determined between MRI and magnetometer-guided SNB and between magnetic and fluorescent SN labelling. MRI revealed 29 SNs (median 4.5, range 0-8 SNs/groin). Twenty-five LNs (median 4.5, range 0-9 LNs/groin) were resected, including 16 magnetically active and 17 fluorescent SNs (median 3, range 0-6 SNs/groin, either mode). MRI and magnetometer-guided SNB had 66% concordance, magnetic and fluorescence SN labelling 96%. The diagnostic accuracy of our approach has to be evaluated in larger patient cohorts. Our radiation-free SNB technique is feasible without the need for nuclear medicine, its associated additional effort and regulations.
侵袭性淋巴结（LN）分期对于阴茎癌（PeCa）患者的生存至关重要。为降低与根治性腹股沟淋巴结清扫术相关的患者发病率，推荐进行前哨淋巴结活检（SNB）。传统放射性/荧光示踪剂用于前哨淋巴结（SN）标记仅限于有核医学的中心，或者缺乏术前成像。我们引入了一种无辐射的荧光磁性混合示踪剂，用于PeCa患者的腹股沟SN双模态成像。在连续3例PeCa患者中，将荧光磁性混合示踪剂（50μl吲哚菁绿，5mg/ml，溶于1ml超顺磁性氧化铁纳米颗粒中）瘤周注射。通过磁共振成像（MRI）可视化SN。术中，使用手持式磁力计和荧光相机检测SN。确定MRI与磁力计引导的SNB之间以及磁性和荧光SN标记之间的一致性。MRI显示29个SN（中位数4.5，范围0 - 8个SN/腹股沟）。切除了25个LN（中位数4.5，范围0 - 9个LN/腹股沟），包括16个有磁性活性的和17个荧光SN（中位数3，范围0 - 6个SN/腹股沟，任何一种模式）。MRI与磁力计引导的SNB一致性为66%，磁性和荧光SN标记一致性为96%。我们方法的诊断准确性必须在更大的患者队列中进行评估。我们的无辐射SNB技术是可行的，无需核医学及其相关的额外工作和规定。
