Since its development (2007) and clinical introduction (2009), the hybrid tracer ICG-99mTc-nanocolloid has revolutionized the way sentinel node resection are performed. (Inter-)national studies that cover a great variety of sentinel node indications (e.g. (head-and-neck) melanoma) have underlined the value of using these multimodal nanoparticles for surgical guidance (>50 papers). In particular their ability to integrate pre- and intra-operative imaging findings can be considered highly advantageous. While ICG-99mTc-nanocolloid is a sentinel node specific tracer that can be detected using nuclear medicine modalities and (near-infrared) fluorescence imaging, the hybrid concept can easily be expanded to (tumor) receptor-targeted tracers. Studies using ICG-99mTc-nanocolloid also provided the basis for many industrial collaborations and both hard- and soft-ware developments.
Schematic overview of the hybrid approach for sentinel node biopsy. Hybrid ICG-99mTc-nanocolloid is intradermally injected in four deposits (total volume 0.4mL) surrouding the (melanoma) (A). Immediately after tracer injection, dynamic lymphoscintigraphy is performed followed by static images at fifteen minutes and two hours post-injection. Thereafter a SPECT/CT scan is acquired (B). Prior to the start of the operation, a volume of approximately 1.0mL patent blue dye is injected after which the injection site is massaged (C). Intraoperatively, SNs are detected using a combination of a gamma probe/portable gamma camera, fluorescence imaging and blue dye detection (D). SN = sentinel node; γ = gamma radiation; λex = excitation wavelength of ICG; λem = emission wavelength of ICG.
- Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. van der Poel HG, Buckle T, Brouwer OR, Valdés Olmos RA, van Leeuwen FW. Eur Urol. 2011 Oct;60(4):826-33.
- Optimisation of fluorescence guidance during robot-assisted laparoscopic sentinel node biopsy for prostate cancer. KleinJan GH, van den Berg NS, Brouwer OR, de Jong J, Acar C, Wit EM, Vegt E, van der Noort V, Valdés Olmos RA, van Leeuwen FW, van der Poel HG. Eur Urol. 2014 Dec;66(6):991-8.
- A hybrid radioactive and fluorescent tracer for sentinel node biopsy in penile carcinoma as a potential replacement for blue dye. Brouwer OR, van den Berg NS, Mathéron HM, van der Poel HG, van Rhijn BW, Bex A, van Tinteren H, Valdés Olmos RA, van Leeuwen FW, Horenblas S. Eur Urol. 2014 Mar;65(3):600-9.
- Luminescence-based Imaging Approaches in the Field of Interventional Molecular Imaging. Van Leeuwen FW, Hardwick JC, van Erkel AR. Radiology. 2015 Jul;276(1):12-29.
- Multimodal Surgical Guidance during Sentinel Node Biopsy for Melanoma: Combined Gamma Tracing and Fluorescence Imaging of the Sentinel Node through Use of the Hybrid Tracer Indocyanine Green-(99m)Tc-Nanocolloid. van den Berg NS, Brouwer OR, Schaafsma BE, Mathéron HM, Klop WM, Balm AJ, van Tinteren H, Nieweg OE, van Leeuwen FW, Valdés Olmos RA. Radiology. 2015 May;275(2):521-9.