The diagnosis of cancer is of major impact for each new patient faced with this dreaded diagnosis. At the beginning of every individual treatment planning the correct staging of the disease is of utmost importance. It is inalienable to know if the tumor has spread to the lymphatics. To exclude any regional metastases different tumors warrant different staging procedures. Possible staging and treatment options are: surgery, watch and wait, primary irradiation, or sentinel node biopsy (SNB). For melanoma and breast surgery SNB is considered to be the standard staging procedure. The goals of SNB are to improve staging, reduce mortality and costs, and be as equally effective as upfront surgery. As of today research focusses on the development of novel accurate tools for the detection of the sentinel node.
The hypothesis behind SNB is as follow: the sentinel lymph node (SLN) is the first draining lymph node for a tumor of a specific site. All other lymph nodes are only reached subsequently. If metastases occur, they first occur in the SLN. The aim of the procedure is to localize and selectively excise the SLN. If the SLN is tumor free, no surgical treatment is warranted, whereas if the SLN shows metastatic tumor deposits, a surgical intervention will be added and the lymphatic drainage basin at risk will be removed. With the combination of a radioactive tracer (99m technetium; 99tc) and a single photon emission tomography (SPECT)camera for the detection of the SLN, the latter can be removed safely.
This research project focuses on the development of a new hand-held device (SPECT camera) with specific focus on faster and better identification of the first echelon node (SLN) in combination with an optical navigation system.
Was ist das Besondere an diesem Projekt?
If we are able to provide the planned mobile SPECT camera device in a handy and surgeon friendly manner the device could be a major step towards hand-held radio-guided sentinel node biopsy technique not only for head and neck surgeons but also for breast and melanoma surgeons. Globally there exists a total of about 20'000 hospitals (US 7'000, EU 10'000, Others 3'000) of which about 20% perform sentinel node biopsies, translating into about 4'000 hospitals worldwide with a potential use of our device. If we calculate 10% applicability for MOONSTAR there is a market for about 400 devices. Besides the technically-inspired research aims, the study will provide new insights into basic lymphatic drainage pathways. There is an increasing interest how malignant drainage is functioning. If one could minimally invasive apply drugs or other agents into the drainage basin one could imagine of minimally invasive target imaging and therapy in the future.
We have created a prototype-like mobile SPECT camera that also sports a video camera. The clever design of the collimator allows augmenting the video camera image with the photons measured with the SPECT camera. With techniques used in compressed sensing we managed to reconstruct the distribution of the 99tc tracer distribution in three-dimensions. Having exact knowledge of the tracer distribution enables better differencing close by lymph nodes. The next step would be to augment the intra-operative ultrasound with the measured tracer distribution.
S. Abdul-Rasool, S. H. Kidson, E. Panieri, D. Dent, K. Pillay, and G. S. Hanekom, «An evaluation of molecular markers for improved detection of breast cancer metastases in
sentinel nodes.» J Clin Pathol , vol. 59, no. 3, pp. 289–297, Mar 2006;
M. S. Vorburger, M. A. Broglie, A. Soltermann, S. K. Haerle, S. R. Haile, G. F. Huber, and S. J. Stoeckli, «Validity of frozen section in sentinel lymph node biopsy for the staging in oral
and oropharyngeal squamous cell carcinoma.» J Surg Oncol , vol. 106, no. 7, pp. 816–819,
P. Hermanek, R. V. Hutter, L. H. Sobin, and C. Wittekind, «International union against cancer. classification of isolated tumor cells and micrometastasis.» Cancer , vol. 86, no. 12, pp. 2668–2673, Dec 1999;
L.-C. Liu, J. E. Lang, Y. Lu, D. Roe, S. E. Hwang, C. A. Ewing, L. J. Esserman, E. Morita, P. Treseler, and S. P. Leong, «Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients: a meta-analysis and single-institution experience.» Cancer , vol. 117, no. 2, pp. 250–258, Jan 2011;
D. B. Husarik and H. C. Steinert, «Single-photon emission computed tomography/computed tomography for sentinel node mapping in breast cancer.» Semin Nucl Med , vol. 37, no. 1, pp. 29–33, Jan 2007;
H. Keski-Säntti, S. Mätzke, T. Kauppinen, J. T¨ornwall, and T. Atula, «Sentinel lymph node mapping using spect-ct fusion imaging in patients with oral cavity squamous cell carcinoma.» Eur Arch Otorhinolaryngol , vol. 263, no. 11, pp. 1008–1012, Nov 2006.
S. K. Haerle, T. F. Hany, K. Strobel, D. Sidler, and S. J. Stoeckli, “Is there an additional value
of spect/ct over planar lymphoscintigraphy for sentinel node mapping in oral/oropharyngeal squamous cell carcinoma?” Ann Surg Oncol , vol. 16, no. 11, pp. 3118–3124, Nov 2009;
O. R. Brouwer, T. Buckle, L. Vermeeren, W. M. C. Klop, A. J. M. Balm, H. G. van der Poel, B. W. van Rhijn, S. Horenblas, O. E. Nieweg, F. W. B. van Leeuwen, and R. A. Vald´es Olmos, «Comparing the hybrid fluorescent-radioactive tracer indocyanine green-99mtc-nanocolloid with 99mtc-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and spect/ct.» J Nucl Med , vol. 53, no. 7, pp. 1034–1040, Jul 2012;
D. A. Heuveling, K. H. Karagozoglu, A. van Schie, S. van Weert, A. van Lingen, and R. de Bree, «Sentinel node biopsy using 3d lymphatic mapping by freehand spect in early stage oral cancer: a new technique.» Clin Otolaryngol , vol. 37, no. 1, pp. 89–90, Feb 2012;
A. Schnelzer, A. Ehlerding, and J. Ettl, «Using freehand spect for 3d navigated radio-guided axillary sentinel lymph node biopsy and quality assurance in breast cancer surgery,» in Proceedings of the Annual San Antonio Breast Cancer Symposium (SABCC) , 2010;
S. Naji, A. Tadros, J. Traub, and C. Healy, «Case report: improving the speed and accuracy of melanoma sentinel node biopsy with 3d intra-operative imaging.» J Plast Reconstr Aesthet Surg , vol. 64, no. 12, pp. 1712–1715, Dec 2011.
Am Projekt beteiligte Personen
Prof. Dr. Philippe C. Cattin
, Projektleiter, Leiter Dept. of Biomedical Engineering, Center for medical Image Analysis and Navigation (CIAN), Universität BaselProf. Dr. med. Stephan Haerle
, Co-Projektleiter, Zentrum für Kopf-Hals-Chirurgie, Hirslanden Klinik St. Anna Luzern, Lehr- und Forschungsbeauftragter an der Universität Basel
Uri Narhun, PostDoc, Departement of Biomedical Engineering, Universität Basel
Simon Pezold, PostDoc, Departement of Biomedical Engineering, Universität Basel
Peter von Niederhäusern, PhD Student, Departement of Biomedical Engineering, Universität Basel
Carlo Seppi, Mathematician, Departement of Biomedical Engineering, Universität Basel
Dr. Ole Maas, Departement für Nuklearmedizin, Universitätsspital Basel
Michael Rissi, DECTRIS AG, Baden/Dättwil
Letzte Aktualisierung dieser Projektdarstellung 14.11.2018