![]() Both techniques, however, lack in-depth information and features that can be complemented through the use of superficial optical imaging/fluorescence guidance. Intraoperative guidance is therefore required in the form of a gamma-ray detection probe (referred to as gamma probe) or portable/handheld gamma cameras that provide a superior sensitivity and high resolution. This information can then be used to provide the basis for a surgical roadmap.ĭifferences in patient placement during preoperative imaging and head-and-neck surgery complicate the direct translation of the preoperative findings to the surgical field of view. This procedure allows preoperative identification of the primary tumor-draining LNs (so-called sentinel nodes (SNs)) using lymphoscintigraphy and single-photon emission computed tomography combined with computed tomography (SPECT/CT) imaging. Over the past decades, the sentinel node (SN) biopsy procedure for loco-regional lymph node (LN) staging in patients with (head-and-neck) melanoma has increasingly gained interest. ![]() The use of gamma camera-based freehandSPECT aids intraoperative lesion identification and, with that, supports the transition from pre- to intraoperative imaging via augmented reality display and directional guidance. In addition, fluorescence imaging allowed for the identification of (clustered) SNs that could not be identified based on navigation alone. Fluorescence imaging provided optical confirmation of the navigation accuracy in all patients. Navigation towards these nodes using the freehandSPECT approach was successful in 13 nodes. Preoperatively, 15 SNs were identified, of which 14 were identified using freehandSPECT. Intraoperative fluorescence imaging was used to confirm the accuracy of the navigation-based approach and identify the exact location of the SNs. For lesion localization during surgery, freehandSPECT scans were projected in an augmented reality video-view that was used to spatially position a gamma-ray detection probe. FreehandSPECT scans were generated in the operation room using a portable gamma camera. Indocyanine green (ICG)- 99mTc-nanocolloid was injected preoperatively, whereafter lymphoscintigraphy and SPECT/CT imaging were performed in order to define the location of the SN(s). Materials and methodsĮight patients with melanoma located in the head-and-neck area were included. In this study, gamma camera-based freehandSPECT was evaluated in combination with the hybrid tracer ICG- 99mTc-nanocolloid. Here, intraoperative navigation-based guidance technologies may provide outcome. Intraoperative sentinel node (SN) identification in patients with head-and-neck malignancies can be challenging due to unexpected drainage patterns and anatomical complexity.
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