Multimodal Imaging Techniques in Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy (SLNB) has become an indispensable procedure for staging various malignancies by identifying the first draining lymph node from a primary tumour. Traditional approaches have relied on blue dye and radiocolloid tracers detected by a handheld gamma probe, yet each modality carries inherent limitations in spatial resolution, depth penetration and contrast. Multimodal imaging seeks to integrate complementary techniques—such as single-photon emission computed tomography fused with computed tomography (SPECT/CT), intraoperative gamma tracing and near-infrared (NIR) fluorescence imaging—to enhance both preoperative planning and real-time surgical guidance. Preoperative SPECT/CT provides three-dimensional mapping of tracer uptake and anatomical landmarks, enabling precise localisation of sentinel nodes and complex drainage pathways. Intraoperatively, gamma probes offer quantitative detection of radiolabelled colloids at depth, while NIR fluorescence imaging with dyes such as indocyanine green affords high-resolution visualisation of lymphatic channels and superficial nodes. Emerging platforms further combine beta-emitting radionuclides or multimodal probes with engineered antibody fragments to improve specificity and reduce background signal. These synergistic strategies not only increase the accuracy of node detection and reduce false negatives but also minimise surgical dissection and operative time. Collectively, multimodal imaging in SLNB exemplifies the shift towards image-guided precision surgery, with implications for improved patient outcomes, tailored oncological management and broader applicability across tumour types and anatomical sites.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Research from all publishers

In a 2024 position paper by a leading nuclear medicine society, the feasibility of β-emitting radionuclides for surgical radioguidance was examined. The authors delineate instrumentation challenges, radiation-safety considerations and potential clinical workflows, emphasising the capacity of β-emitters to confine signal to the operative field, thereby enhancing node-to-background contrast. Optimization of detector sensitivity and tracer selection emerged as key factors for translation. A 2023 study introduced a genetically encoded multifunctional handle for single-domain antibody tracers carrying 99mTc and an NIR fluorophore. Site-specific labelling enabled bimodal imaging in tumour-bearing models, demonstrating concordant SPECT/CT localisation and fluorescence-guided resection with high tumour-to-background ratios. This work underlines the value of modular tracer design to unify deep-tissue detection with optical precision. Another 2023 review of intraoperative gamma cameras surveyed a spectrum of portable designs, comparing collimation schemes, detector materials and readout strategies. Performance metrics such as sensitivity, spatial resolution and field of view were benchmarked across 17 systems. The analysis highlighted trends towards lightweight, high-resolution detectors integrated with augmented reality overlays to facilitate rapid localisation of radiolabelled sentinel nodes under sterile conditions. Together, these studies illustrate a concerted effort to refine both hardware and tracer chemistry for seamless multimodal SLNB.

Multimodal Imaging Techniques in Sentinel Lymph Node Biopsy publication trend

The graph below shows the total number of articles in multimodal imaging techniques in sentinel lymph node biopsy across all publications each year (not limited to Nature Index journals).

Technical terms

Sentinel Lymph Node Biopsy (SLNB): A surgical procedure to identify and analyse the first lymph node(s) draining a primary tumour.

SPECT/CT: A hybrid imaging modality combining single-photon emission computed tomography with computed tomography for anatomical and functional mapping.

Radioguidance: Intraoperative use of a handheld detector to localise radiolabelled tracers within tissues.

Near-Infrared (NIR) Fluorescence Imaging: Optical imaging technique using NIR dyes for high-contrast visualisation of lymphatic structures.

Gamma Probe: A portable radiation detector tuned to γ-emitting isotopes, used to pinpoint tracer accumulation intraoperatively.

Single-Domain Antibody (sdAb): A small, engineered antibody fragment with high affinity for specific molecular targets and rapid tissue kinetics.

Tracer: A compound labelled with a radioactive isotope and/or fluorescent dye to visualise biological pathways.

References

1. Surgical radioguidance with beta-emitting radionuclides; challenges and possibilities: A position paper by the EANM. European Journal of Nuclear Medicine and Molecular Imaging (2024).
2. The GEM-handle as convenient labeling strategy for bimodal single-domain antibody-based tracers carrying 99mTc and a near-infrared fluorescent dye for intra-operative decision-making. Frontiers in Immunology (2023).
3. Intraoperative Gamma Cameras: A Review of Development in the Last Decade and Future Outlook. Journal of Imaging (2023).