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Updated: Mar 18, 2026
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Multispectral Fluorescence Imaging During Robot-assisted Laparoscopic Sentinel Node Biopsy: A First Step Towards a
Nynke S van den Berg1, Tessa Buckle2, Gijs H KleinJan1
1Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
This study shows that combining indocyanine green-99mTc-nanocolloid with fluorescein improves sentinel lymph node biopsy accuracy. Multispectral fluorescence imaging is feasible for guiding surgery and enhancing oncologic outcomes.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Imaging
Background:
- Sentinel lymph node (SN) biopsy enhances radioguided excision using intraoperative fluorescence imaging.
- A hybrid tracer, indocyanine green-99mTc-nanocolloid, enables combined pre- and intraoperative SN identification.
- Integrating a lymphangiographic tracer with the SN tracer may improve SN biopsy accuracy.
Purpose of the Study:
- To clinically evaluate a multispectral fluorescence-guided surgery approach.
- To assess the utility of indocyanine green-99mTc-nanocolloid and fluorescein in SN biopsy.
- To determine the feasibility of using a commercial fluorescence laparoscope for SN identification.
Main Methods:
- A pilot study involved ten prostate cancer patients undergoing robot-assisted radical prostatectomy.
- Patients received indocyanine green-99mTc-nanocolloid preoperatively, followed by intraprostatic fluorescein injection.
- A multispectral fluorescence laparoscope was used for intraoperative identification of both fluorescent signatures.
Main Results:
- Indocyanine green-99mTc-nanocolloid visualized 85.3% of sentinel lymph nodes via near-infrared fluorescence imaging.
- Fluorescein imaging accurately identified lymphatic ducts in 8/10 patients, despite background staining and tracer washout.
- The primary limitation was the small patient cohort.
Conclusions:
- A lymphangiographic tracer offers supplementary information in SN biopsy using indocyanine green-99mTc-nanocolloid.
- Multispectral fluorescence image-guided surgery demonstrates clinical feasibility.
- This approach may improve guidance towards diseased tissue, sparing healthy tissue for better outcomes.
