Radio-Guided Lymph Node Mapping in Bladder Cancer Using SPECT/CT and Intraoperative γ-Probe Methods

Połom, Wojciech; Gruszecka, Agnieszka; Markuszewski, Marcin; Cytawa, Wojciech; Lass, Piotr; Matuszewski, Marcin

doi:10.1097/rlu.0000000000001523

Cited by 2 publications

(14 citation statements)

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“…25,[28][29][30][31] In our study, the preoperative SN visualization rate on a per-patient basis was 53%, although lower than other SN applications, this value is in line with the 23% to 94% range described in the literature. [12][13][14][15][16][17] As seen in the study by Liedberg et al, 18 omitting the preoperative imaging, the percentage of SN identification dropped to 23%. We found that preoperative nonvisualization was highly related to the chance of intraoperative SN identification.…”

Section: Discussionmentioning

confidence: 93%

“…We saw a bilateral drainage in 40% of the patients with preoperative imaging, which is in line with the literature of radiocolloid-based SN localization. 14 However, studies using only free ICG reported a much higher bilateral drainage pattern (90%). Arguing that in pursuit of precision surgery "less is more," one can argue that use of lymphangiographic rather than SN-specific agents means the procedure drifts away from its original minimally invasive concept.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have explored the feasibility of SN mapping in bladder cancer patients using radioactive colloid, blue, and fluorescent dyes as separated modalities. [13][14][15][16][17][18][19][20][21] Unfortunately, most studies are based on relatively small patient groups. The studies are also not mutually comparable to ours because of differences in the injection technique and type of tracer that was used.…”

Section: Discussionmentioning

confidence: 99%

“…Sentinel node (SN) biopsy can provide a less invasive and more personalized lymph node (LN) dissection. The SNs that usually are the first site of tumor seeding, preceding systemic spreading, [12][13][14][15][16][17] can be preoperatively identified by mapping-via lymphoscintigraphy and SPECT/CT-the drainage profile of a radiocolloid. This procedure was initially described for bladder cancer by Sherif et al 12 Intraoperative SN identification was realized by complementing the preoperative imaging roadmap with the use of gamma probe to identify the radiocolloids.…”

mentioning

confidence: 99%

“…Alternative means for intraoperative SN identification have been pursued using blue dye and/or the fluorescence dye indocyanine green (ICG). [12][13][14][15][16][17][18][19][20][21][22][23][24] In the present study, we have used the hybrid tracer ICG-99m Tc-nanocolloid in patients with MIBC who underwent RC with or without neoadjuvant chemotherapy (NAC). This hybrid tracer has successfully been used for SN biopsy in various malignancies 25 but, so far, remained undocumented in bladder cancer.…”

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confidence: 99%

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Evaluation of the Hybrid Tracer Indocyanine Green–99mTc-Nanocolloid for Sentinel Node Biopsy in Bladder Cancer—A Prospective Pilot Study

Rietbergen¹,

Gennep²,

KleinJan

et al. 2022

Clin Nucl Med

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Rationale In muscle-invasive bladder cancer (MIBC), lymph node invasion has proven to be an independent predictor of disease recurrence and cancer-specific survival. We evaluated the feasibility of targeting the sentinel node (SN) for biopsy in MIBC patients using the hybrid tracer indocyanine green (ICG)– 99m Tc-nanocolloid for simultaneous radioguidance and fluorescence guidance. Methods Twenty histologically confirmed cN0M0 MIBC patients (mean age, 63.3 years; range, 30–82 years), scheduled for radical cystectomy with SN biopsy and extended pelvic lymph node dissection (ePLND), were prospectively included. Twelve patients were operated on following neoadjuvant chemotherapy. The patients received lymphoscintigraphy as well as SPECT/CT after 4 transurethral injections of ICG- 99m Tc-nanocolloid (mean, 208 MBq; range, 172–229 MBq) around the tumor/scar in the detrusor muscle of the bladder on the day before radical cystectomy. Sentinel node resection was performed under radioguidance and fluorescence guidance. Results Nineteen patients could be analyzed. On preoperative imaging, SNs could be identified in 10 patients (53%; mean, 1.6 SN/patient), which revealed drainage pathways outside the ePLND in 20% of the patients. Interesting to note is that 2 patients (10%) with preoperative nonvisualization displayed fluorescent and radioactive SNs during surgery. Location of the primary tumor near the left lateral side of the bladder seemed to be a factor for nonvisualization. Nodal harvesting with ePLND varied among patients (mean, 23.3). Histopathology confirmed tumor-positive nodes in 4 (21%) of all patients. In the 2 patients where an SN could be identified, the ePLND specimens were tumor-negative. All patients with tumor-positive nodes had advanced disease (stage III). Conclusion Sentinel node biopsy in bladder cancer using the hybrid tracer ICG- 99m Tc-nanocolloid is feasible, and preoperative imaging is predictive for the ability to perform SN biopsy in 83% of the patients who displayed an SN. In patients with a successful preoperative SN mapping using lymphoscintigraphy and SPECT/CT, the intraoperative SN guidance and detection were effective, even outside the ePLND area. As such, this study underscores the critical role that preoperative imaging plays in challenging image-guided surgery applications.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of the Hybrid Tracer Indocyanine Green–99mTc-Nanocolloid for Sentinel Node Biopsy in Bladder Cancer—A Prospective Pilot Study

Rietbergen¹,

Gennep²,

KleinJan

et al. 2022

Clin Nucl Med

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Near‐infrared fluorescence lymph node template region dissection plus backup lymphadenectomy in open radical cystectomy for bladder cancer using an innovative handheld device: A single center experience

Püllen,

Costa,

Darr

et al. 2024

Journal of Surgical Oncology

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BackgroundThe extent of pelvic lymphadenectomy (PLND) as part of radical cystectomy (RC) for bladder cancer (BC) remains unclear. Sentinel‐based and lymphangiographic approaches could lead to reduced morbidity without sacrificing oncologic safety.ObjectiveTo evaluate the feasibility and diagnostic value of fluorescence‐guided template sentinel region dissection (FTD) using a handheld near‐infrared fluorescence (NIRF) camera in open radical cystectomy.Design, Setting, and ParticipantsAfter peritumoral cystoscopic injection of indocyanine green (ICG) 21 patients underwent open RC with FTD due to BC between June 2019 and June 2021. Intraoperatively, the FIS‐00 Hamamatsu Photonics® NIRF camera was used to identify and resect fluorescent template sentinel regions (FTRs) followed by extended pelvic lymphadenectomy (ePLND) as oncological back‐up.Outcome Measurement and Statistical AnalysisDescriptive analysis of positive and negative results per template region.Results and LimitationsFTRs were identified in all 21 cases. Median time (range) from ICG injection to fluorescence detection was 75 (55–125) minutes. On average (SD), 33.4 (9.6) lymph nodes were dissected per patient. Considering template regions as the basis of analysis, 67 (38.3%) of 175 resected regions were NIRF‐positive, with 13 (7.4%) regions harboring lymph node metastases. We found no metastatic lymph nodes in NIRF‐negative template regions. Outside the standard template, two NIRF‐positive benign nodes were identified.ConclusionThe concept of NIRF‐guided FTD proved for this group all lymph node metastases to be found in NIRF‐positive template regions. Pending validation in a larger collective, resection of approximately 40% of standard regions may be sufficient and may result in less morbidity.

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Radio-Guided Lymph Node Mapping in Bladder Cancer Using SPECT/CT and Intraoperative γ-Probe Methods

Cited by 2 publications

References 3 publications

Evaluation of the Hybrid Tracer Indocyanine Green–99mTc-Nanocolloid for Sentinel Node Biopsy in Bladder Cancer—A Prospective Pilot Study

Evaluation of the Hybrid Tracer Indocyanine Green–99mTc-Nanocolloid for Sentinel Node Biopsy in Bladder Cancer—A Prospective Pilot Study

Near‐infrared fluorescence lymph node template region dissection plus backup lymphadenectomy in open radical cystectomy for bladder cancer using an innovative handheld device: A single center experience

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