Hybrid techniques for intraoperative sentinel lymph node imaging: early experiences and future prospects

Sentinel lymph node biopsy (SLNB) has become widely accepted as a standard of care in the surgical staging of the axilla in breast cancer patients, and it has been increasingly used as a staging procedure for various other malignancies such as melanoma, head and neck cancer, and gynecological and urogenital malignancies. SLNB accurately predicts regional nodal status, determines prognosis and is helpful in devising therapeutic strategies. In spite of these achievements, there is a need to advance the intraoperative identification beyond the current state-of-the-art. This will help facilitate surgeons to find sentinel lymph nodes (SLNs) more accurately. Accurate visualization appears to be essential during surgeries in complex areas, as frequently observed in malignancies with deep lymphatic drainage or with drainage to multiple basins. By placing the SLNs within their anatomical context, the introduction of SPECT/CT, in addition to lymphoscintigraphy, has significantly improved the generation of preoperat...