REVIEWS  PERSPECTIVES IN RADIOGUIDED SURGERY AND SENTINEL LYMPH NODE BIOPSY TWENTY YEARS LATER 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2014 June;58(2):193-206

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Hybrid tracers for sentinel node biopsy

Van Den Berg N. S. ^{1, 2}, Buckle T. ¹, Kleinjan G. I. ^{1, 2}, Klop W. M. ³, Horenblas S. ⁴, Van Der Poel H. G. ⁴, Valdés-Olmos R. A. ^{1, 2}, Van Leeuwen F. I. ^{1, 3} ✉

¹ Interventional Molecular Imaging Laboratory, Department of Radiology Leiden University Medical Center, Leiden, The Netherlands; ² Department of Nuclear Medicine, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; ³ Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; ⁴ Department of Urology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

Conventional sentinel node (SN) mapping is performed by injection of a radiocolloid followed by lymphoscintigraphy to identify the number and location of the primary tumor draining lymph node(s), the so-called SN(s). Over the last decade research has focused on the introduction of new imaging agents that can further aid (surgical) SN identification. Different tracers for SN mapping, with varying sizes and isotopes have been reported, most of which have proven their value in a clinical setting. A major challenge lies in transferring this diagnostic information obtained at the nuclear medicine department to the operating theatre thereby providing the surgeon with (image) guidance. Conventionally, an intraoperative injection of vital blue dye or a fluorescence dye is given to allow intraoperative optical SN identification. However, for some indications, the radiotracer-based approach remains crucial. More recently, hybrid tracers, that contain both a radioactive and fluorescent label, were introduced to allow for direct integration of pre- and intraoperative guidance technologies. Their potential is especially high when they are used in combination with new surgical imaging modalities and navigation tools. Next to a description of the known tracers for SN mapping, this review discusses the application of hybrid tracers during SN biopsy and how the introduction of these new techniques can further aid in translation of nuclear medicine information into the operating theatre.