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Make a choice Prof. dr. E.C.J. Consten drs. T.A. Burghgraef dr. A.R. Wijsmuller Prof. dr. G.M. van Dam drs. D.J. Sikkenk

Project properties

Title	Pilot studies to assess the safety and feasibility of sentinel lymph node identification in colon carcinoma with ICG or ICG-99mTc-nanocolloid.
Keywords	Colon carcinoma Sentinel lymph node Fluorescence imaging
Researchers	Prof. dr. E.C.J. Consten drs. T.A. Burghgraef dr. A.R. Wijsmuller Prof. dr. G.M. van Dam drs. D.J. Sikkenk
Nature of the research	Clinical research
Fields of study	surgery oncology pathology

Background / introduction

Lymph node staging is important for the optimal treatment of colon carcinoma. In case of regional lymph node metastasis adjuvant chemotherapy is given. Although stage I and II colon carcinoma patients do not have lymph node metastasis, up until 30% develop recurrent disease or distant metastasis, perhaps this is due to understaging as a result of ‘missed’ lymph node (micro) metastasis. Furthermore, true stage I and II colon carcinoma patients are subjected to a segmental colonic resection, with unnecessary additional morbidity as a result. Advanced histological examination, like PCR, serial slicing or immunohistochemistry are known to improve accuracy and reduce understaging. However this is too expensive and time consuming too perform in all stage I and II colon carcinoma patients. The sentinel lymph node (SLN) in colon carcinoma might provide a solution. As this first draining lymph node is known to have the highest chance of containing metastatic tumour cells, targeted advanced histological examination might result in upstaging. Identification of the SLN with indocyanine green (ICG) or Technetium-99m has shown encouraging results, however a high rate of false negatives is seen, which causes a problematic lack of sensitivity. However with new injection techniques, and combination of both modalities, sensitivity might improve.

Research question / problem definition
The primary aim is to assess safety and feasibility of ICG and Technetium for identification of the SLN in colon carcinoma. Secondary aims are sensitivity and specificity.

Workplan
- Perform pilot studies for the use of ICG and ICG-99mTc-nanocolloid. - Analyse and quantify intensity of NIR/ICG and gamma emmission in correlation with lymph nodes. - Test new immunohistochemical markers for the identification of metastases, which might serve as a tumour-specific tracer with ICG/99mTc.