Real-time sentinel lymph node biopsy guidance using combined ultrasound, photoacoustic, fluorescence imaging: in vivo proof-of-principle and validation with nodal obstruction.
Precise sentinel lymph node (SLN) identification is crucial not only for accurate diagnosis of micro-metastases at an early stage of cancer progression but also for reducing the number of SLN biopsies (SLNB) to minimize their severe side effects. Furthermore, it is desirable that an SLNB guidance should be as safe as possible in routine clinical use. Although there are currently various SLNB guidance methods for pre-operative or intra-operative assessment, none are ideal. We propose a real-time SLNB guidance method using contrast-enhanced tri-modal images (i.e., ultrasound, photoacoustic, and fluorescence) acquired by a recently developed hand-held tri-modal probe. The major advantage of tri-modal imaging is demonstrated here through an in vivo study of the technically-difficult case of nodal obstruction that frequently leads to false-negative results in patients. The results in a tumor model in rabbits and normal controls showed that tri-modal imaging is capable of clearly identifying obstructed SLNs and of indicating their metastatic involvement. Based on these findings, we propose an SLNB protocol to help surgeons take full advantage of the complementary information obtained from tri-modal imaging, including for pre-operative localization, intra-operative biopsy guidance and post-operative analysis.
Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea.
Jeeun
J
Kang
Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea.|Sogang Institute of Advanced Technology, Sogang University, Seoul, 04107, South Korea.|Department of Biomedical Engineering, Sogang University, Seoul, 04107, South Korea.
Jin Ho
JH
Chang
Department of Radiology, Seoul National University of Bundang Hospital, Kyeonggi-do, 13620, South Korea.
Sun Mi
SM
Kim
Department of Radiology, Seoul National University of Bundang Hospital, Kyeonggi-do, 13620, South Korea.
Hak Jong
HJ
Lee
Department of Biomedical Engineering, Sogang University, Seoul, 04107, South Korea.
Haemin
H
Kim
Princess Margaret Cancer Centre, University Health Network, M5G 1L7, Canada.|Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Ontario M5G 1L7, Canada.
Brian C
BC
Wilson
Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea.
Tai-Kyong
TK
Song
D000818:Animals; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D064847:Multimodal Imaging; D009369:Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D061848:Optical Imaging / Q000379:methods; D059035:Perioperative Period; D017410:Practice Guidelines as Topic; D011817:Rabbits; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography / Q000379:methods; D057188:Workflow