Sentinel lymph node mapping using ICG fluorescence and cone beam CT \u2013 a feasibility study in a rabbit model of oral cancer

Nidal Muhanna,Michael J Daly,Jonathan Bernstein,Jonathan C Irish,Harley H L Chan,Catriona M Douglas,Donovan Eu,Jason L Townson,Atul Jaidka

doi:10.1186/s12880-020-00507-x

Abstract

BackgroundCurrent sentinel lymph node biopsy (SLNB) techniques, including use of radioisotopes, have disadvantages including the use of a radioactive tracer. Indocyanine green (ICG) based near-infrared (NIR) fluorescence imaging and cone beam CT (CBCT) have advantages for intraoperative use. However, limited literature exists regarding their use in head and neck cancer SLNB.MethodsThis was a prospective, non-randomized study using a rabbit oral cavity VX2 squamous cell carcinoma model (n = 10) which develops lymph node metastasis. Pre-operatively, images were acquired by MicroCT. During surgery, CBCT and NIR fluorescence imaging of ICG was used to map and guide the SLNB resection.ResultsIntraoperative use of ICG to guide fluorescence resection resulted in identification of all lymph nodes identified by pre-operative CT. CBCT was useful for near real time intraoperative imaging and 3D reconstruction.ConclusionsThis pre-clinical study further demonstrates the technical feasibility, limitations and advantages of intraoperative NIR-guided ICG imaging for SLN identification as a complementary method during head and neck surgery.

Highlights

Current sentinel lymph node biopsy (SLNB) techniques, including use of radioisotopes, have disadvantages including the use of a radioactive tracer
Sentinel lymph node biopsy (SLNB) is a well-established technique used in many subsites of oncology, including breast cancer, skin cancer and melanoma
The most recent National Comprehensive Cancer Network (NCCN) clinical practice guidelines for head and neck oncology and National Institute for Clinical Excellence (NICE) guidelines addresses the clinical dilemma of the N0 neck in early stage (T1/T2) oral cancer, stating that sentinel lymph node biopsy is an alternative to elective neck dissection for identifying occult cervical metastasis [6]

Summary

Introduction

Current sentinel lymph node biopsy (SLNB) techniques, including use of radioisotopes, have disadvantages including the use of a radioactive tracer. The most recent National Comprehensive Cancer Network (NCCN) clinical practice guidelines for head and neck oncology and National Institute for Clinical Excellence (NICE) guidelines addresses the clinical dilemma of the N0 neck in early stage (T1/T2) oral cancer, stating that sentinel lymph node biopsy is an alternative to elective neck dissection for identifying occult cervical metastasis [6]. Despite these guidelines, sentinel lymph node biopsy is not well established or frequently used in clinical practice due to technical difficulties and the tracer commonly used being radioactive

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