With the introduction of the hybrid tracer indocyanine green (ICG)-(99m)Tc-nanocolloid, a direct relation between preoperative imaging and intraoperative fluorescence-guidance was established. However, fluorescence guidance is limited by its superficial nature. This study evaluated the feasibility of a nuclear medicine-based navigation concept that allowed intraoperative positioning of a fluorescence camera (FC) in the vicinity of preoperatively defined ICG-(99m)Tc-nanocolloid containing sentinel nodes (SNs).
Five patients with penile cancer scheduled for SN biopsy were injected with ICG-(99m)Tc-nanocolloid followed by preoperative SPECT/CT imaging. The navigation device was used to provide a real-time augmented reality overlay of the SPECT/CT images and video output of the FC. This overlay was then used for FC navigation.
SPECT/CT identified thirteen SNs in nine groins. FC navigation was successful for all twelve intraoperatively evaluated SNs (average error: 8.8 mm, range: 0-20 mm).
This study reveals the potential benefits of FC navigation during open surgery procedures.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2016 May 26 [Epub ahead of print]
Gijs H KleinJan, Nynke S van den Berg, Matthias N van Oosterom, Thomas Wendler, Mitsuharu Miwa, Axel Bex, Kees Hendricksen, Simon Horenblas, Fijs Wb van Leeuwen
Leiden University Medical Center, Netherlands;, Leiden University Medical Center, Netherlands;, Leiden University Medical Center, Netherlands;, Computer Aided Medical Procedures (CAMP), Technische Universität München, Germany;, Development Center Hamamatsu Photonics K.K., Japan;, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Netherlands;, Antoni van Leeuwenhoek Hospital, Netherlands;, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Netherlands;, Leiden University medical Center, Netherlands.