Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 14;20(1):106.
doi: 10.1186/s12880-020-00507-x.

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

Nidal Muhanna  1   2   3   4 , Harley H L Chan  2 , Catriona M Douglas  5   6   7 , Michael J Daly  2 , Atul Jaidka  2 , Donovan Eu  1   2 , Jonathan Bernstein  1   2   3 , Jason L Townson  2 , Jonathan C Irish  1   2   3
Affiliations

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

Nidal Muhanna et al. BMC Med Imaging. .

Abstract

Background: Current 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.

Methods: This 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.

Results: Intraoperative 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.

Conclusions: This 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.

Keywords: Cone beam CT; Head and neck cancer; Head and neck surgery; Indocyanine green; Near-infrared fluorescence imaging; Sentinel lymph node biopsy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Work flow b buccal cancer; c microCT demonstrating the tumor and lymph node; d surface rendering from microCT. e NIR fluorescence view of lymph node
Fig. 2
Fig. 2
Surgical guidance using intraoperative NIR fluoresence imaging in head and neck surgery with VX2 carcinoma bearing New Zealand White rabbit in buccal area: a subcutaneous ICG injection. b Intraoperative NIR fluorescence imaging. c White light image - lymph node. d NIR fluorescence image - lymph node. e Fluorescence green pseudo-color image overlay on white light image
Fig. 3
Fig. 3
CT [(a)-(c)] and fluorescence [(d)-(f)] images of 3 rabbit lymph nodes
Fig. 4
Fig. 4
a lymph node location on CBCT; b Surface rendering from CBCT; c lymph node after skin exposure; d lymph node after fascia removed; e fluorescence in lymph vessels; f NIR fluorescence image corresponding to (e)
Fig. 5
Fig. 5
Comparison of pre-operative microCT (top) and intra-operative CBCT images for SLN imaging. a,b,c Axial, coronal and sagittal view on microCT. d,e,f The same rabbit and same views with cone beam CT
Fig. 6
Fig. 6
Analysis sequence for lymph node fluorescence imaging in intraoperative surgical guidance resecting the target: a percutaneous NIR fluorescence image; b in situ NIR fluorescence image; c in situ NIR fluorescence image of LN-A in Rabbit 4 with signal-to-background (SBR) ratios, the SBR for region-of-interest 1 and 2 are 6.0 and 4.6, respectively; d ex-vivo NIR fluorescence image of resected lymph node; e Pathology examination of tissue slice stained with hematoxylin and eosin (H&E); f Pathology examination of tissue slice with pan-cytokeratin straining (AE1/AE3). Note: H&E and AE1/AE3 slice suggest the resected lymph node is positive which correspondent to surgeon’s anatomical inspection
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Dik EA, et al. Watchful waiting of the neck in early stage oral cancer is unfavourable for patients with occult nodal disease. Int J Oral Maxillofac Surg. 2016;45(8):945–950. doi: 10.1016/j.ijom.2016.03.007. - DOI - PubMed
    1. Schilling C, et al. Sentinel lymph node biopsy for oral squamous cell carcinoma. Where are we now? Br J Oral Maxillofac Surg. 2017;55(8):757–762. doi: 10.1016/j.bjoms.2017.07.007. - DOI - PubMed
    1. Abu-Ghanem S, et al. Elective neck dissection vs observation in early-stage squamous cell carcinoma of the Oral tongue with no clinically apparent lymph node metastasis in the neck: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2016;142(9):857–865. doi: 10.1001/jamaoto.2016.1281. - DOI - PubMed
    1. Tardelli E, et al. Sentinel lymph node biopsy in cutaneous melanoma: standard and new technical procedures and clinical advances. A systematic review of the literature. Clin Nucl Med. 2016;41(12):e498–e507. doi: 10.1097/RLU.0000000000001370. - DOI - PubMed
    1. El Hage Chehade H, et al. Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg. 2016;212(5):969–981. doi: 10.1016/j.amjsurg.2016.07.018. - DOI - PubMed

Publication types

MeSH terms

Substances